Innovative VETERINARY CARE
VOLUME 14 ISSUE 2
REGENERATIVE MEDICINE AS AN ALTERNATIVE TO ORGAN TRANSPLANTATION HOW THIS CUTTING-EDGE THERAPY COULD IMPROVE PROGNOSIS IN PATIENTS WITH CONDITIONS LIKE CHRONIC RENAL FAILURE AND HEPATIC FIBROSIS. — P. 8
INTEGRATIVE APPROACH TO FELINE LIVER DISEASE
SUPPORTING JOINT HEALTH WITH NUTRITIONAL STRATEGIES
HOW CHIROPRACTIC CARE PROMOTES MOBILITY IN AGING DOGS
TREATING CANINE ARTHRITIS WITH ESSENTIAL OILS
STREAMLINE YOUR PRACTICE BY CREATING YOUR OWN APPS
TOP 5 LESSONS FROM CLINICAL VETERINARY PRACTICE
Manage liver disease in cats by considering a treatment regimen that includes diet, IV therapies, castor oil packs and more. — p. 44
SPRING 2024
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This alternative modality can be used to effectively identify and treat primary causes of musculoskeletal dysfunction in canine patients. — p. 32
Developing custom veterinary apps offers a valuable opportunity to improve your practice, elevate patient care, and foster stronger connections with clients. — p. 36
A balanced diet, glycosaminoglycans, and quick-acting pain-relieving herbs can be used along with weight management and exercise to keep canine joints healthy. — p. 12
Learn how essential oils can be used alongside medications to provide relief in dogs with arthritis. — p. 26
A career as a veterinarian involves continuous learning as well as personal and professional growth. It will also humble you more times than you can count. — p. 40
SPRING 2024 EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Omer Rashid, DVM Senior Content Editor: Ashley Tonkens Senior Content Editor: Belinda Rose-Innes Graphic Design Lead: Ethan Vorstenbosch Graphic Designer: Joy Sunga
COLUMNISTS & CONTRIBUTING WRITERS Susan Albright, DVM Chris Bessent, DVM, MSOM, Dipl. OM, LAc Nancy Brandt, DVM, OMD, MSOM, dip. OM, CVC, CVA, CVMA W. Jean Dodds, DVM Hannah Godfrey, BVetMed, MRCVS Cynthia Lankenau, DVM Melissa L. Magnuson, DVM Jared Mitchell, DVM, CVMA, CVA, CVFT Judy Morgan, DVM, CVA, CVCP, CVFT Emily Singler, VMD
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improving the lives of animals... one reader at a time.
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FEATURES
MEDICINE FOR 8 REGENERATIVE ORGAN FAILURE IN DOGS — WHERE DO WE STAND?
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by Hannah Godfrey, BVETMED, MRCVS
by Jared Mitchell, DVM, CVMA, CVA, CVFT
Regenerative medicine is a potentially effective alternative to organ transplantation in dogs, and could improve prognosis in chronic renal failure and hepatic fibrosis.
Conventional medications provide relief for canine arthritis, but often have side effects. Essential oils can be used alongside conventional treatments, or on their own.
12 NUTRITIONAL STRATEGIES FOR JOINT HEALTH IN DOGS NUTRITION NOOK
by Chris Bessent, DVM, MSOM, DIPL. OM, LAC Used with weight management and adequate exercise, nutritional strategies for joint health in dogs include a balanced diet, glycosaminoglycans, and quickacting pain-relieving herbs.
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OF REGENERATIVE 18 APPLICATIONS MEDICINE IN VETERINARY HEMATOLOGY by W. Jean Dodds, DVM How regenerative medicine and stem cell therapy are being utilized to enhance hematological knowledge in pets and treat related conditions in these species.
CONSTRUCTION: USING 22 UNDER BIOENGINEERED SCAFFOLDS TO REPAIR AND REPLACE CANINE TISSUE
by Emily Singler, VMD
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Bioengineered scaffolds will likely become available as an advanced modality for dogs in need of tissue replacement.
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OILS FOR TREATING ARTHRITIS IN DOGS 26 ESSENTIAL
CARE FOR AGING DOGS: PROMOTING 32 CHIROPRACTIC MOBILITY by Judy Morgan, DVM, CVA, CVCP, CVFT Chiropractic care is an effective diagnostic and therapeutic modality for identifying and treating primary causes of musculoskeletal dysfunction in dogs.
DEVELOPMENT FOR VETERINARY PRACTITIONERS 36 APP by Omer Rashid, DVM
Developing custom veterinary apps offers a valuable opportunity to improve and streamline your practice, elevate patient care, and foster stronger connections with clients.
TOP 5 LESSONS FROM VETERINARY PRACTICE 40 MYCLINICAL by Melissa L. Magnuson, DVM
A career as a veterinarian involves continuous learning as well as personal and professional growth. It will also humble you more times than you can count.
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INTEGRATIVE APPROACH TO TREATING LIVER DISEASE IN FELINES by Nancy Brandt, DVM, OMD, MSOM, DIP. OM, CVC, CVA, CVMA Liver disease in cats can rapidly become serious. An integrative approach that includes diet, IV therapies, castor oil packs and more can help manage the condition.
advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is coowner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
COLUMNS & DEPARTMENTS
7 Editorial 11 From the AHVMA 25 From the VMAA 31 Industry Innovations 35 From the IVAS 46 From the VBMA IN THE NEWS:
17 New study reveals urgent need for retention strategies in veterinary profession
21 American Bar Association advocates for non-animal testing methods
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
39 Breakthrough treatment for FIP utilizes human COVID-19 drug
47 Veterinary mid-level practitioner role gains traction in Colorado and Florida
Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.
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1. CHRIS BESSENT, DVM, MSOM, DIPL. OM, LAC
5. MELISSA L. MAGNUSON, DVM
Dr. Chris Bessent has over 30 years of experience in veterinary medicine, and has certificates in veterinary acupuncture, veterinary chiropractic, and veterinary Chinese herbology. She also received her degree in veterinary nutrition and founded The Simple Food Project, formulating freeze-dried raw food diets for cats and dogs using nothing but whole foods. Currently, Dr. Bessent divides her time between The Simple Food Project and Herbsmith, a manufacturer of premium quality supplements for pets. Both are owned and operated out of her facilities in southeastern Wisconsin (simplefoodproject.com, herbsmithinc.com). p.12
Dr. Melissa Magnuson always wanted to be a veterinarian and fulfill her passion for helping animals. She has a degree in biology and philosophy from Hamline University in St. Paul, MN, and a master’s degree from Southern Mississippi University. She was one of nine researchers to be trained to run an automated DNA sequencer, and helped map the pine genome. From there, she completed her DVM at the University of Minnesota, where she participated in mapping the pig and canine genomes. Dr. Magnuson has a special interest in surgery, emergency medicine, and avian and exotic animal care, and owns and operates three AAHA accredited small animal and exotic veterinary practices in New Hampshire. p.40
2. NANCY BRANDT, DVM, OMD, MSOM, DIP. OM, CVC, CVA, CVMA
6. JARED MITCHELL, DVM, CVMA, CVA, CVFT
Dr. Nancy Brandt graduated from the University of Minnesota College of Veterinary Medicine in 1990, and later began her studies in acupuncture, Chinese medicine, chiropractic medicine, and naturopathic modalities. In 1999, she founded her practice, Natural Care Institute, and in 2017, she founded UnBound Center for Animal Wellness, for special needs pets. Dr. Brandt pioneered the field of Veterinary Medical Aromatherapy® and founded the Veterinary Medical Aromatherapy Association (nancybrandtdvm.com, sparkeducationonline.com). p.44
Dr. Jared Mitchell graduated from Mississippi State University’s College of Veterinary Medicine in 2004, and owns Mitchell Animal Clinic in Mobile, Alabama. He has advanced training in essential oils through the VMAA and has published articles for several peer-reviewed journals. Dr. Mitchell is certified in veterinary acupuncture and veterinary food therapy through Chi University, and is enrolled in their Masters of TCVM program. p.26
7. JUDY MORGAN, DVM, CVA, CVCP, CVFT 3. W. JEAN DODDS, DVM Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. p.18
Dr. Judy Morgan graduated from the University of Illinois College of Veterinary Medicine in 1984. She is certified in Veterinary Orthopedic Manipulation, and in Acupuncture and Food Therapy from the Chi Institute, as well as acupuncture, food therapy, and chiropractic care. She has authored four books on holistic pet care, and has over 700 educational videos on Facebook and YouTube (drjudymorgan.com). p.32
8. EMILY SINGLER, VMD 4. HANNAH GODFREY, BVETMED MRCVS Hannah Godfrey is a small animal veterinary surgeon practicing in Cardiff, UK. She has over ten years of clinical experience, and has undertaken additional training in dentistry and soft tissue surgery. Hannah also provides quality client-facing written communication on common pet health issues; writes content and communications for veterinary professionals; and edits medical and veterinary medical journal articles. She holds the position of Community Lead for VetLed, a Veterinary Human Factors training provider. p.8
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Dr. Emily Singler is a 2001 graduate of Penn State University and a 2005 graduate of University of Pennsylvania School of Veterinary Medicine. She has experience in shelter medicine and private practice, and currently works as a veterinary writer, consultant, and mentor. Dr. Singler has written and consulted for Fetch Pet Insurance; her other writing interests include preventive medicine and the human-animal bond. She authored Pregnancy and Postpartum Considerations for the Veterinary Team (CRC Press, November 2023), and shares educational and supportive content on her social media channels, website and blog through her brand Vet Med Baby (vetmedbaby.com). p.22
editorial
EMBRACING THE FUTURE with Regenerative Medicine I have always found it remarkable how beings like salamanders and starfish can regenerate their bodies without any foreign intervention. Can we take inspiration from these creatures, and help our animal patients recover from organ damage or other maladies that are currently difficult to deal with? The answer is yes. As veterinary professionals, we’re constantly seeking innovative approaches to enhance the care and well-being of our animal patients. One frontier that holds tremendous promise is regenerative medicine. This emerging field focuses on harnessing the body's natural ability to heal and regenerate tissues, offering new avenues for treating a wide range of conditions and injuries. Regenerative medicine encompasses a variety of techniques aimed at promoting tissue repair and regeneration. From stem cell therapy to platelet-rich plasma (PRP) injections, these modalities hold immense potential for addressing musculoskeletal injuries, degenerative joint disease, and even organ failure. By tapping into the body's innate healing mechanisms, regenerative medicine offers a new approach to veterinary care, with the potential to improve outcomes and quality of life for our patients. In this issue of IVC Journal, we are privileged to feature several articles exploring different facets of regenerative medicine. Dr. Jean Dodds sheds light on the application of regenerative medicine in veterinary hematology, showcasing its potential for treating blood disorders and promoting hematopoiesis. Dr. Hannah Godfrey addresses the use of regenerative medicine for organ failure, and sparks discussion on the challenges and opportunities in this evolving field. And Dr. Emily Singler talks about the advancements and challenges of bioengineered scaffolds for tissue regeneration, with insights into the future of regenerative medicine research.
This issue highlights a variety of other interesting topics as well. Dr. Jared discusses the use of essential oils for canine arthritis, focusing on the potential benefits of this natural approach for managing pain and inflammation. Meanwhile, chiropractic care for aging dogs is addressed by Dr. Judy Morgan, who explores how this alternative therapy can promote mobility and overall well-being in senior canine patients. Dr. Chris Bessent shares insights into the role of diet in promoting joint health in canines, emphasizing the importance of proper nutrition for managing musculoskeletal conditions. On the feline side, Dr. Nancy Brandt takes a natural approach to liver toxicity in cats by exploring dietary interventions and herbal remedies for supporting liver function and detoxification. As we witness the evolving landscape of veterinary medicine, it is essential to embrace technology and innovation. We discuss how digital apps can make veterinary solutions more accessible to practitioners and pet owners alike, thereby facilitating communication and improving patient care. And Dr. Melissa Magnuson shares the top five lessons she’s learned from her practice, and offers valuable insights for veterinary professionals at all stages of their careers. As we continue to explore the applications of regenerative medicine and other modalities, let us also embrace innovation and collaboration to advance the field of veterinary medicine and improve the lives of our animal patients. Best regards,
Omer Rashid, DVM, MSc Parasitology Associate Editor, dromer@redstonemediagroup.com IVC Spring 2024
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Regenerative medicine for organ failure in dogs w here do we stand? BY HANNAH GODFREY, BVETMED, MRCVS
Though further studies are required, regenerative medicine using mesenchymal stem cells is a potentially effective alternative to organ transplantation in dogs, and could significantly improve the prognosis of conditions like chronic renal failure and hepatic fibrosis.
lineages.1,3,4 This means that, depending on influencing factors in their environment, these cells can become functional tissue in various body organs. The therapeutic use of stem cells was first proposed in 1991 by Caplan.1 Stem cells are increasingly used in human medicine, but despite their potential, their use in veterinary medicine has primarily been limited to treating equine and canine musculoskeletal conditions.
When treating organ failure in dogs, whether kidney or liver, our primary goals have been to support remaining functional tissue and prevent further damage. The liver has a better natural capacity for healing and regeneration than the kidneys; in the latter, damaged nephrons do not regain function, and the remaining healthy tissue has to compensate to avoid azotemia and clinical signs. However, recent advancements in regenerative medicine have shown promise for its use in organ failure as well as musculoskeletal pathologies. This article aims to give a clear overview of stem cell use in dogs, outlining current research, clinical applications, and future prospects, while addressing limitations and ethical considerations.
There are two broad types of stem cells — embryonic stem cells, which facilitate the development of various cell lines to create fetal tissues, and adult mesenchymal stem cells (MSCs),4 which allow continued regeneration, maintenance, and repair. Since MSCs can be easily harvested, isolated, and cultured without ethical concerns, these are the most appropriate and commonly used therapeutic stem cells.1,5
WHAT IS REGENERATIVE MEDICINE? Regenerative medicine involves encouraging the growth, repair, or replacement of damaged or diseased cells, tissue, or organs to restore function1,2 It aims to provide the necessary tools and building blocks, create the optimum environment for tissue growth and repair, or stimulate the body’s normal healing processes. To achieve this, stem cells and platelet-rich plasma may be used.
WHAT ARE STEM CELLS? Stem cells are undifferentiated cells that can self-renew and have the potential to differentiate into cells from different
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WHERE ARE MESENCHYMAL STEM CELLS FOUND? MSCs have been demonstrated in various tissues of common companion animal species, including the bone marrow, adipose, and dental tissue, and tissues of the joints, bones, muscles, umbilicus, placenta, uterus, and oral cavity.1 Studies have also demonstrated the presence of MSCs in the brain, spleen, liver, kidney, lung, muscle, thymus, and pancreas of mice,6 leading to the reasonable conclusion that MSCs may exist throughout all tissues and organs.
WHERE ARE MESENCHYMAL STEM CELLS HARVESTED FROM? Despite the many potential sources of MSCs, relatively few are currently used as harvest sites. The most commonly-used are bone marrow and adipose tissue. MSCs can be harvested
from adipose tissue relatively easily with a minimally invasive procedure, and the cells retain their quality and ability to replicate, making this site preferable.7 The type of adipose used for stem cell harvest makes a difference. Studies show that MSCs from subcutaneous adipose tissue have better proliferation and osteogenic potential, and remain multi-purpose for longer, than MSCs from visceral adipose tissue.5 Harvesting subcutaneous adipose tissue is also far less invasive than harvesting visceral adipose tissue, further supporting its position as the leading source of MSCs in dogs.5.8 Another consideration when harvesting from adipose tissue is cell availability, which is affected by body condition score.8 Omental adipose tissue has been suggested as a preferred site for MSC harvest, since an appropriate amount of adipose tissue will be present regardless of body condition score.8 Furthermore, this site delivers high cell yield and good proliferation and paracrine potential.8 Since MSCs are not just effective as a source of new cells for regenerating damaged tissue, but also have an immunomodulatory and anti-inflammatory effect, this paracrine function can enhance the success of stem cell treatment by altering the local environment.1,4
DO STEM CELLS HAVE TO BE HARVESTED FROM THE DOG RECEIVING THE TREATMENT? Stem cells can be autologous (donor and recipient are the same animal),7 allogeneic (donor and recipient are different animals, but the same species), or xenogeneic (donor and recipient are different species).1 Autologous stem cells are ideal and the most commonly used; however, the process of isolating and expanding the stem cells is costly
and takes time. Equally, if the recipient dog is sick or elderly, their stem cell quality may be affected. For this reason, the use of allogeneic stem cells from young and healthy donors is becoming increasingly popular, despite the risk of triggering an immune response if the cells are recognized as “non-self”. Just as with blood transfusions in dogs, a single allogeneic treatment is unlikely to cause a reaction, but a reaction would be more likely if treatments are repeated.1
HOW ARE STEM CELLS CURRENTLY USED IN VETERINARY MEDICINE? In veterinary medicine, stem cell therapy was initially used for tendon injuries in horses, but more recently it has been used to treat musculoskeletal conditions in dogs,2,10 such as osteoarthritis and spinal cord injuries.11 Their use in canine arthritis is widely confirmed in the literature, including an Italian study that demonstrated the clinical benefit of stem cell use in dogs with elbow osteoarthritis; the study showed an initial reduction in clinical signs and longer-term improvement in joint health.7
WHAT ARE THE POTENTIAL FUTURE USES FOR STEM CELLS IN DOGS? Thanks to the ease and minimally invasive nature of harvesting, the abundance of stem cells within each patient, and the positive clinical results of current therapy, stem cells doubtlessly represent an exciting prospect for the future capabilities of veterinary medicine. MSCs show promise as a possible therapeutic option for many animal diseases, such as orthopedic, dental, gastrointestinal, hepatic, renal, cardiac, respiratory, neuromuscular, dermal, olfactory, and urogenital conditions.1
Are there any risks, drawbacks, or ethical concerns? The most ethical method of stem cell therapy in dogs involves using autologous MSCs harvested from the subcutaneous adipose tissue. This method avoids the use of a donor animal, while the minimally invasive harvest should reduce pain and stress in the patient. The main drawback of stem cell therapy is a lack of comprehensive understanding. Research results are not yet conclusive regarding the effectiveness
and safety of these treatments, although current findings are promising. Therefore, risks remain that patients may exhibit side effects, or that the treatment effects may not be as positive or long-lasting as preliminary studies have suggested. Aside from thorough understanding and conclusive evidence, another obstacle to the more widespread use of stem cell therapy in dogs is the associated cost.2
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WHAT DOES THE EVIDENCE SAY ABOUT STEM CELL USE FOR ORGAN FAILURE? Rodent models have confirmed the therapeutic benefits of stem cells for improving renal structure and function in acute renal injuries.9 However, in the majority of studies, stem cell therapy was provided soon after partial nephrectomy, which does not replicate the timeframe in which pet owners would seek veterinary advice, investigation, and referral for dogs with chronic renal failure.9 The effectiveness of stem cell use in chronic renal failure is not as well documented, but rodent models show improved renal parameters on biochemistry and improved appearance on histology.4,9 Therefore, a larger bank of research is required, particularly in companion animal species, to confirm stem cell effectiveness for kidney disease, especially chronic renal failure. It is also worth noting that, to be as effective as possible in treating end-stage renal failure, decellularization may be required to remove the non-functional, damaged cells and create space for three-dimensional regeneration. This procedure has been demonstrated in canine cadavers.12 Aside from renal indications, the literature also shows promising results from stem cell treatment in canine liver cirrhosis models13 and dogs with induced hepatic injury, with improved hepatic structure and function on histology and a reduction in liver parameters on blood biochemistry.14 While the use
of stem cells to treat myocardial infarction is established in humans, this condition is relatively rare in dogs.15 Currently, studies have not confirmed positive outcomes from the use of stem cells in common canine cardiac conditions. However, early studies suggest potential clinical benefits from using deciduous tooth-derived stem cells to treat valvular diseases.16 While the majority of current stem cell therapies in dogs involve autologous cells, research shows that non-autologous cells are also effective. Stem cells from both the same and different species have been demonstrated as beneficial in the treatment of acute kidney injury. One study noted the resolution of renal damage and endoplasmic reticular stress following stem cell treatment in both mice and dogs.17 Similarly, stem cells isolated from a camel’s Wharton’s jelly led to improved azotemia and a one-stage reduction in the IRIS stage in dogs with chronic renal failure.18
CONCLUSION Previously, in veterinary patients with organ failure, transplantation was the only treatment option that offered hope of long-term return to function, and organ transplant surgeries are uncommon in dogs. MSCs present a potentially effective alternative to transplantation and could mark a real advancement in the prognosis of conditions like chronic renal failure and hepatic fibrosis. While research so far suggests MSCs are safe and effective, further studies are required before MSC treatment becomes commonplace for organ failure in dogs.
How is stem cell treatment given to dogs? Stem cells are sometimes administered directly to the site where they are required. When the site can be easily accessed, direct administration of the cells to the damaged tissue is effective. An example is administering stem cells via intraarticular injection in dogs with osteoarthritis.7 When the therapeutic target is the kidney, subcapsular and intraparenchymal administration are both effective.9 Equally, stem cells can migrate to areas where regeneration or repair is required. This was demonstrated in a study where stem cells were identified in the renal tissue of rats with chronic renal failure following an intravenous stem cell injection.4 Therefore, in the treatment of renal disease, intravenous administration of stem cells also appears to be effective.9
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REFERENCES Voga M, Adamic N, Vengust M, Majdic G. Stem Cells in Veterinary Medicine—Current State and Treatment Options. Frontiers in Veterinary Science. 2020;7:278.
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Mocchi M, Dotti S, Bue MD, et al. Veterinary Regenerative Medicine for Musculoskeletal Disorders: Can Mesenchymal Stem/Stromal Cells and Their Secretome Be the New Frontier? Cells. 2020;9(6):1453.
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Ding DC, Shyu WC, Lin SZ. Mesenchymal stem cells. Cell Transplantation. 2011;20:5-14.
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Quimby J. Applications of Stem Cell Therapy in Kidney Disease. Veterinary Information Network. June 27, 2013. Available at: vin.com/apputil/project/defaultadv1.aspx?pId=99&catId=14649& id=6133833. Accessed February 02, 2024.
From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
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Yaneselli KM, Kuhl CP, Terraciano PB, et al. Comparison of the characteristics of canine adipose tissuederived mesenchymal stem cells extracted from different sites and at different passage numbers. Journal of Veterinary Science. 2018;19(1):13-20.
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Meirelles LdS, Chagastelles PC, Nardi NB. Mesenchymal stem cells reside in virtually all post-natal organs and tissues. Journal of Cell Science. 2006;119:2204-13.
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Guercio A, Marco PD, Casella S, et al. Production of canine mesenchymal stem cells from adipose tissue and their application in dogs with chronic osteoarthritis of the humeroradial joints. Cell Biology International. 2012;36:189-94.
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Bahamondes F, Flores E, Cattaneo G, Bruna F, Conget P. Omental adipose tissue is a more suitable source of canine Mesenchymal stem cells. BMC Veterinary Research. 2017;13:166.
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Save the dates for the 2024 AHVMA Annual Conference and Exhibition in Reno, Nevada from September 28 through October 1. Expect over 100 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past seven years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education. This year’s Keynote Address, “The Changing Landscape of Veterinary Medicine” by Madeline Yamate, will have us looking at the positive ways holistic veterinarians can help change veterinary medicine.
Kim EY, Kil TY, Kim MK. Case report: Amniotic fluid-derived mesenchymal stem cell treatment in a dog with a spinal cord injury. Veterinary and Animal Science. 2023;22:100318.
You will also find lectures on Photobiomodulation, Ozone, Homeopathy, Botanical Medicine, TCVM, Homotoxicology, Aromatherapy, and much more! Look for our introductory talks on various holistic modalities. Not only will you be exposed to a wealth of knowledge, but you will also acquire information on how to integrate these modalities into your practice. We encourage students from AVMA Accredited Veterinary Schools to attend these lectures as a way to broaden their veterinary education.
Tajima K, Kuroda K, Otaka Y, et al. Decellularization of canine kidney for three-dimensional organ regeneration. Veterinary World. 2020;13(3):452-457.
AHVMA RETREAT
Stem Cell Therapy for CKD: What do we know?. IRIS: International Renal Interest Society. 2018. iriskidney.com/pdf/Stem_Cell.pdf. Accessed February 02, 2024.
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Royal Veterinary College. Canine stem cell therapy -- information for referring vets. Royal Veterinary College, University of London. 2023. Available at: rvc.ac.uk/small-animal-vet/specialist-referrals/ advanced-techniques/stem-cell-clinic/information-for-vets. Accessed February 02, 2024.
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Matsuda T, Takami T, Sasaki R, et al. A canine liver fibrosis model to develop a therapy for liver cirrhosis using cultured bone marrow-derived cells. Hepatology Communications. 2017;1(7):691-703.
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Yan Y, Fang J, Wen X, et al. Therapeutic applications of adipose-derived mesenchymal stem cells on acute liver injury in canines. Research in Veterinary Sciences. 2019;126:233-239.
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Kang MH, Park HM. Challenges of stem cell therapies in companion animal practice. Journal of Veterinary Science. 2020;21(3):e42.
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El-Husseiny HM, Mady EA, Helal MAY, Tanaka R. The Pivotal Role of Stem Cells in Veterinary Regenerative Medicine and Tissue Engineering. Veterinary Sciences. 2022;9(11):648.
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The 2024 AHVMA Annual Retreat is hosted by the Council of Elders and takes place immediately after the AHVMA Conference. It runs October 1 through 3 at Camp Richardson on Lake Tahoe. More details regarding lodging and registration for the retreat will be forthcoming on the AHVMA website.
INTERESTED IN SPEAKING AT THE 2025 CONFERENCE?
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The Conference Program Committee is no longer accepting submissions for the 2024 Conference; however, be on the lookout for the 2025 Call for Papers portal to open.
Miniawy HMFE, Farghali HA, Khattab MS, et al. The therapeutic potential of Camel Wharton jelly mesenchymal stem cells (CWJ-MSCs) in canine chronic kidney disease model. Stem Cell Research and Therapy. 2022;13:387.
Submitted by Melissa Kellagher, AHVMA Director of Operations
He W, Qin D, Li B, et al. Immortalized canine adipose-derived mesenchymal stem cells alleviate gentamicin-induced acute kidney injury by inhibiting endoplasmic reticulum stress in mice and dogs. Research in Veterinary Science. 2021;136:39-50.
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nutrition nook IN AM
Nutritional strategies for JOINT HEALTH IN DOGS BY CHRIS BESSENT, DVM, MSOM, DIPL. OM, LAC
Used alongside weight management and adequate exercise, nutritional strategies for joint health in dogs include a balanced diet, glycosaminoglycans, and quick-acting pain-relieving herbs.
Supporting canine joint health through nutrition begins with a complete and balanced diet. Such a diet must provide protein, glucose, vitamins, minerals, Omega-3 fatty acids, and antioxidants. In combination with glycosaminoglycans and immediate pain-relieving and anti-inflammatory herbs, these dietary components cater to all aspects of the joint. Employing these nutritional strategies along with healthy weight maintenance and adequate exercise is crucial to supporting your canine patients’ joint health.
Fats, especially Omega-3 fatty acids, help reduce inflammation and benefit joint health. In particular, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) can be highly beneficial due to their anti-inflammatory properties. Omega-3 fatty acids can alter the production of inflammatory eicosanoids, prostaglandins, and leukotrienes, leading to a decreased inflammatory response1,2 By integrating into the cell membranes of joint tissues, Omega-3s can lead to the production of less potent inflammatory compounds.
THE BUILDING BLOCKS OF LONG-TERM JOINT HEALTH
Chronic systemic inflammation can lead to cartilage degradation. By reducing whole-body inflammation, Omega-3 fatty acids help protect the joints against further damage from leukocyte-mediated tissue injury. They also help improve blood flow to the tissues, including those in the joints. Omega3s are not direct pain reducers, but by decreasing joint inflammation and degradation, they can indirectly lead to a reduction in pain and discomfort for the dog.3,4
Macronutrients Including proteins, fats, and glucose, macronutrients play essential roles in the overall joint health of dogs. The right balance of these macronutrients is vital. High quality protein is crucial for maintaining muscle mass; strong muscles can help support and stabilize joints. Adequate protein intake ensures the body has the necessary components to repair and maintain joint tissues.
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Omega-3 fatty acids also contribute to brain and skin health, and can help maintain a healthy coat. This overall boost in health can indirectly support a dog’s ability to cope with the challenges of joint disease.5,6
The therapeutic dose of EPA and DHA for a dog with osteoarthritis is 147 mg/kg/day, with the NRC’s safe upper limit being 175 mg/kg/day. AAFCO does not have a minimum EPA/ DHA requirement for adult canine maintenance. In contrast, the EPA/DHA requirement for canine growth and reproduction diets is 0.05% dry matter basis or 10 mg/100 kcal.
Antioxidants Antioxidants play a crucial role in managing degenerative joint disease in dogs by combating oxidative stress and inflammation, two key factors contributing to joint injury progression. Oxidative stress occurs when an imbalance occurs between free radicals (unstable molecules that can damage cells) and antioxidants in the body. This stress can contribute to inflammation and damage to joint tissues. Antioxidants neutralize free radicals, thereby protecting the cells, including those in the joints, from damage. Many antioxidants have anti-inflammatory properties. By reducing inflammation, they can help alleviate pain and slow the progression of joint damage. The synovium can be affected by oxidative stress and inflammation; antioxidants help protect the synovium, thereby maintaining the health of the entire joint structure. By protecting cartilage from oxidative damage, antioxidants contribute to preserving joint function and reducing pain. Vitamins such as C and E are well-known antioxidants. Unlike humans, canines can synthesize endogenous vitamin C production, which can be upregulated with increased oxidative stress. Other dietary compounds like carotenoids and flavonoids, found in various fruits and vegetables, also have antioxidant properties.7
IMMEDIATE PAIN-RELIEVING AND ANTI-INFLAMMATORY HERBS Incorporating certain herbs into a dog's diet can provide natural support for managing joint pain symptoms. These herbs are known for their anti-inflammatory, pain-relieving, and joint-protective properties.
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Green-lipped mussel (GLM), native to New Zealand, is increasingly recognized for its potential benefits in managing osteoarthritis in dogs. It contains a high concentration of Omega-3 fatty acids, including EPA and DHA, as well as glycosaminoglycans (GAGs), including chondroitin sulfate. GLM also contains antioxidants that can help combat oxidative stress and reduce damage to joint tissues. By mitigating oxidative damage, the antioxidants in GLM can help preserve joint health.18-21 GLM is also a source of essential minerals and vitamins that can support overall health. It contains zinc and manganese, important for bone health and the repair of connective tissues.
contains curcumin, known for its potent 2 Turmeric anti-inflammatory and antioxidant properties. Supple-
menting turmeric extract (6.60 mg/kg body weight of curcumin) for 60 days led to a downregulation of inflammatory genes in circulating white blood cells of dogs with a history of OA.19 Turmeric combined with ground black pepper can increase the herb’s efficiency.22-24 Corydalis (Corydalis yanhusuo) is a traditional herbal
3 remedy used for centuries in various cultures to
help manage pain and inflammation. It's known for its analgesic and sedative properties. The primary benefit of Corydalis is its ability to help manage pain. It contains a compound called dehydrocorybulbine (DHCB), which has been found to reduce inflammatory and neuropathic pain. Corydalis may also have antiinflammatory and mild sedative effects.25,26
oswellia, also known as Indian Frankincense, is 4 Bderived from the resin of the Boswellia serrata tree. It
has been traditionally used for its anti-inflammatory and pain-relieving properties. Boswellia contains active compounds known as boswellic acid, which can inhibit the production of leukotrienes and help reduce inflammation and alleviate pain.26,27
Boswellia is safe and less likely to cause the gastrointestinal irritation sometimes associated with conventional non-steroidal anti-inflammatory drugs (NSAIDs). It can be used in combination with other supplements, such as glucosamine and chondroitin, Omega-3 fatty acids, or turmeric, potentially leading to synergistic effects that enhance the overall benefits for joint health.
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Micronutrients can help reduce inflammation, repair and protect joint structures, and improve overall joint function. • Vitamin C is a potent antioxidant that helps combat oxidative stress and reduce inflammation in the joints. It also plays a role in collagen synthesis, an essential component of cartilage. • V itamin E has strong antioxidant properties that help protect joint tissues from oxidative damage. It supports the immune system and can help alleviate inflammation in the joints.8 • Z inc and manganese are essential for bone health and assist in forming connective tissues and cartilage. They are also involved in the production of collagen and proteoglycans. • Selenium has antioxidant properties that can help protect the joints from oxidative stress and damage.
Glycosaminoglycans These important nutrients are obtained through a wild canine’s natural diet, mainly by consuming the tissues of prey animals which are rich in this compound.9 The natural diet of a wild canine is diverse and balanced enough to support joint health. • J oint and connective tissues: Wild canines consume the entire carcass of their prey, which includes the joints and connective tissues. Joint fluid is a source of hyaluronic acid, and connective tissue is one of the best dietary sources of collagen. • B one and marrow: Wild canines often chew on the bones of their prey. This not only provides calcium and other minerals but also exposes the bone marrow. Bone marrow, and the cartilage caps on the ends of bones, can be sources of glucosamine and chondroitin. • L igaments and tendons: These parts of the prey’s body are rich in collagen and other proteins that support joint health. While they don't directly provide glucosamine, they supply essential nutrients for maintaining joint integrity and function.
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A dog’s body, much like the human body, can synthesize endogenous glucosamine. This is crucial for maintaining the health and resilience of cartilage. In healthy dogs, this process ensures the cartilage is maintained and repaired as needed. However, as dogs age, or suffer from joint conditions like arthritis, the natural production of glucosamine can decrease, potentially leading to the degradation of cartilage and the onset of arthritis symptoms. Additionally, domestic dogs may not always have access to such a range of natural nutrients in their diets, especially if they are fed a highly-processed commercial diet. The meatprocessing industry is structured to first retrieve the parts of the animal that humans consume, which is around 60% of the animal. The other parts of the carcass can be value added material for different industries, particularly the pet food industry. In the dismemberment of a beef cow, for example, the muscle meats and organs are utilized in the human and pet food industries. However, the long bones of cattle are difficult to grind for a calcium source, and the cartilage caps are labor-intensive to harvest. In the current meat harvesting industry, long bones with cartilage caps are disposed of via the rendering process. Although smaller bones may make their way into pet food, most of the cartilage is rendered, leaving standard pet food void of the nutrients needed to support joint health.
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Without access to natural joint-supporting nutrients, the following supplemental glycosaminoglycans (GAGs) should be used with commerciallyprocessed pet foods. • G lucosamine is a building block for cartilage proteoglycans. Cartilage comprises several components, including water, collagen, proteoglycans (which attract and retain water to maintain the spongy nature of cartilage), and chondrocytes (cells that produce cartilage). Glucosamine regulates collagen synthesis in cartilage and may provide mild antiinflammatory effects. Therefore, it can help in the formation and repair of cartilage as well as play a role in producing viscose synovial fluid.10-13 When it comes to supplementing glucosamine for joint health in dogs, the dosage is not based on the amount found in natural cartilage, but on the amount shown to be beneficial in clinical studies. For dogs, a common glucosamine dosage is often in the range of 20 mg per pound (about 44 mg/kg) of body weight per day. • C hondroitin contributes to cartilage resilience by attracting water into the tissue, making it more elastic and capable of withstanding stress. It can help block the destructive enzymes that break down cartilage and joint fluid. By inhibiting these enzymes, chondroitin supports the maintenance of cartilage and prevents its breakdown. A chondroitin dose of 15-30 mg/kg has been
suggested, but there are few in vitro studies that provide bioavailability and pharmacokinetic data.13,13 • H yaluronic Acid (HA) occurs naturally in the body, and is found in high concentrations in the synovial fluid that lubricates the joints, as well as in connective tissues and skin. It’s known for its lubricating and shock-absorbing properties. HA contributes to the viscosity of synovial fluid, providing a lubricating layer. This can reduce friction and wear on the cartilage, potentially alleviating pain and improving mobility. By maintaining elasticity and viscosity of the joint fluid, HA helps absorb the shocks to the joints that occur during movement, protecting them from further damage. HA can also reduce inflammation and is involved in cartilage regeneration and repair. Dietary sources of glucosamine, chondroitin, and hyaluronic acid are the building blocks of cartilage and synovial fluid. Therefore, when used together, they are thought to have a synergistic effect. Veterinarians commonly recommend glucosamine and chondroitin for treating osteoarthritis in canines despite the lack of compelling scientific evidence demonstrating clinical benefits. Their effectiveness can vary between individuals, and they are generally considered part of a long-term management strategy rather than a short-term solution.12,13 • C ollagen is an essential protein naturally found in the body. It is a key component of cartilage, tendons, and ligaments, helping
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to maintain the strength and elasticity of these tissues.14-17 Collagen acts as a “cushion” within the joints, allowing bones to move smoothly over each other. As dogs get older, collagen production decreases, leading to joint health deterioration. Collagen supplements, often derived from marine sources or chicken sternum, can help maintain collagen levels in the dog’s body, potentially aiding in joint health.
enriched therapeutic diets and nutraceuticals in canine and feline osteoarthritis. International Journal of Molecular Sciences 23, 10384. Gupta RC, Canerdy TD, Lindley J, Konemann M, Minniear J, Carroll BA, et al.. Comparative therapeutic efficacy and safety of type-II collagen (UC-II), glucosamine and chondroitin in arthritic dogs: pain evaluation by ground force plate. J Anim Physiol Anim Nutr. (2012) 96:770–7. 10.1111/j.1439-0396.2011.01166.x. 12
McCarthy G, O'Donovan J, Jones B, McAllister H, Seed M, Mooney C. Randomised double-blind, positivecontrolled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J. (2007) 174:54–61. 10.1016/j.tvjl.2006.02. 13
Comblain F, Barthélémy N, Lefèbvre M, et al. (2017) A randomized, double-blind, prospective, placebocontrolled study of the efficacy of a diet supplemented with curcuminoids extract, hydrolyzed collagen and green tea extract in owner's dogs with osteoarthritis. BMC Veterinary Research 13, 395. 14
Nutritional strategies for managing joint health in dogs involve a holistic approach: one that relies on a balanced diet rich in antioxidants and Omega-3 fatty acids, appropriate exercise, weight management, and GAGS such as glucosamine, chondroitin, and hyaluronic acid. With this strategy and the addition of quick-acting, pain-relieving herbs such as Corydalis, boswellia, and turmeric (see sidebar on page 41), you are caring for your canine patients’ short- and long-term joint health.
Deparle LA, Gupta RC, Canerdy TD, et al. (2005) Efficacy and safety of glycosylated undenatured type-II collagen (UC-II) in therapy of arthritic dogs. Journal of Veterinary Pharmacology and Therapeutics 28, 385-390. 15
Vandeweerd JM, Coisnon C, Clegg P, et al. (2012) Systematic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. Journal of Veterinary Internal Medicine 26, 448-456. 16
Varney JL, Fowler JW, Coon CN. (2022) Impact of supplemented undenatured type II collagen on pain and mobility in healthy Labrador retrievers during an exercise regimen. Translational Animal Science 6, txac12. 17
Hielm-Björkman A, Tulamo RM, Salonen H. et al. (2009) Evaluating complementary therapies for canine osteoarthritis part I: green-lipped mussel (Perna canaliculus). Evidence-based Complementary and Alternative Medicine 6, 397263. 18
Adler N, Schoeniger A, Fuhrmann H. (2018) Polyunsaturated fatty acids influence inflammatory markers in a cellular model for canine osteoarthritis. Journal of Animal Physiology and Animal Nutrition 102, e623-e632. 1
Mehler SJ, May LR, King C, et al. (2016) A prospective, randomized, double blind, placebo-controlled evaluation of the effects of eicosapentaenoic acid and docosahexaenoic acid on the clinical signs and erythrocyte membrane polyunsaturated fatty acid concentrations in dogs with osteoarthritis. Prostaglandins, Leukotrienes, and Essential Fatty Acids 109, 1-7. 2
Buddhachat K, Siengdee P, Chomdej S, et al. (2017) Effects of different omega-3 sources, fish oil, krill oil, and green-lipped mussel against cytokine-mediated canine cartilage degradation. In Vitro Cellular & Developmental Biology. Animal 53, 448-457. 3
Moreau M, Troncy E, Castillo DEL, et al. (2013) Effects of feeding a high omega-3 fatty acids diet in dogs with naturally occurring osteoarthritis. Journal of Animal Physiology and Animal Nutrition 97, 830-837. 4
Fritsch DA, Allen TA, Dodd CE, et al. (2010) A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. Journal of the American Veterinary Medical Association 236, 535-539. 5
Barrouin-Melo SM, Anturaniemi J, Sankari S, et al. (2016) Evaluating oxidative stress, serological- and haematological status of dogs suffering from osteoarthritis, after supplementing their diet with fish or corn oil. Lipids in Health and Disease 15, 139.
Sgorlon S, Stefanon B, Sandri M, Colitti M. (2016). Nutrigenomic activity of plant derived compounds in health and disease: results of a dietary intervention study in dog. Research in Veterinary Science, 109(December), 142–148. 19
Servet E, Biourge V, Marniquet P. (2006) Dietary intervention can improve clinical signs in osteoarthritic dogs. The Journal of Nutrition 136, 1995S-1997S. 20
Bierer TL, Bui LM. (2002) Improvement of arthritic signs in dogs fed green-lipped mussel (Perna canaliculus). The Journal of Nutrition 132, 1634S-1636S. 21
Paultre K, Cade W, Hernandez D, et al. (2021) Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review. BMJ Open Sport & Exercise Medicine 7, e000935. 22
Hewlings SJ, Kalman DS. Curcumin: A Review of Its Effects on Human Health. Foods. 2017 Oct 22;6(10):92. doi: 10.3390/foods6100092. PMID: 29065496; PMCID: PMC5664031. 23
Henrotin Y, Clutterbuck AL, Allaway D, et al. (2010) Biological actions of curcumin on articular chondrocytes. Osteoarthritis and Cartilage 18, 141-149. 24
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Alhassen L, Dabbous T, Ha A, Dang LHL, Civelli O. The Analgesic Properties of Corydalis yanhusuo. Molecules. 2021 Dec 10;26(24):7498. doi: 10.3390/molecules26247498. PMID: 34946576; PMCID: PMC8704877. 25
Martello E, Bigliati M, Adami R, Biasibetti E, Bisanzio D, Meineri G, Bruni N. Efficacy of a dietary supplement in dogs with osteoarthritis: A randomized placebo-controlled, double-blind clinical trial. PLoS One. 2022 Feb 16;17(2):e0263971.
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Tanprasertsuk J, Tate DE, Shmalberg J. Roles of plant-based ingredients and phytonutrients in canine nutrition and health. J Anim Physiol Anim Nutr (Berl). 2022 May;106(3):586-613. doi: 10.1111/jpn.13626. Epub 2021 Sep 8. PMID: 34495560; PMCID: PMC9291198.
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Chin KY, Ima-Nirwana S. (2018) The role of vitamin E in preventing and treating osteoarthritis – a review of the current evidence. Frontiers in Pharmacology 9, 946.
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Pye C, Clark N, Bruniges N, Peffers M, Comerford E. (2024), Current evidence for non-pharmaceutical, nonsurgical treatments of canine osteoarthritis. J Small Anim Pract, 65: 3-23. 9
Altman RD. (2009) Glucosamine therapy for knee osteoarthritis: pharmacokinetic considerations. Expert Review of Clinical Pharmacology 2, 359-371. 10
Barbeau-Grégoire M, Otis C, Cournoyer A, et al. (2022) A 2022 systematic review and meta-analysis of
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Reichling J, Schmökel H, Fitzi J, Bucher, S. , & Saller, R. (2004). Dietary support with Boswellia resin in canine inflammatory joint and spinal disease. Schweizer Archiv Fur Tierheilkunde, 146(2), 71–79. 10.1024/00367281.146.2.71.
In the news
NEW STUDY REVEALS URGENT NEED FOR RETENTION STRATEGIES IN VETERINARY PROFESSION The American Animal Hospital Association (AAHA) has released a groundbreaking study titled “Stay, Please: Factors that Support Retention and Drive Attrition in the Veterinary Profession.” This study sheds light on the critical realities demanding attention within the veterinary ecosystem. The first of its kind from AAHA, it delves into factors influencing retention and attrition among veterinary professionals, offering valuable insights for leaders and managers in the field. Key findings from the study highlight a concerning trend: a significant portion of the veterinary workforce is contemplating leaving their current positions. Specifically, the study reveals 30% of surveyed veterinary professionals currently in clinical practice, projected at nearly 74,000 individuals, plan to depart within the next year. Shockingly, half of those planning to leave — approximately 37,500 individuals — are considering leaving clinical practice altogether, with a staggering 90% expressing no intention of returning to the field. The study underscores the magnitude of the issue, estimating that
over 25,500 veterinarian providers — equivalent to 13.5% of those in clinical roles — are planning to exit the profession permanently. In response to these alarming statistics, the AAHA presents two proposed strategies for practices aiming to improve retention: a holistic approach and a role-based perspective.
11. The holistic approach emphasizes a multi-step strategy that addresses both the operational aspects of practices and the fundamental needs of team members. Key steps include ensuring fair compensation, fostering appreciation for work, supporting career development, and promoting caring leadership. Additionally, practices are encouraged to cultivate factors that make people want to stay, such as fostering teamwork, offering flexibility in scheduling and job duties, and supporting staff well-being.
members have distinct motivations and objectives. This persona-based approach enables practices to tailor retention strategies to the unique needs and perspectives of different team members. Overall, the AAHA’s study serves as a clarion call for action within the veterinary profession, urging stakeholders to prioritize retention efforts and address the root causes of attrition. As veterinary practices grapple with workforce challenges, the insights provided by the “Stay, Please” study offer a roadmap for fostering a supportive and sustainable environment for veterinary professionals. https://www.aaha.org/practice-resources/ research-center/white-paper-form-the-pathto-increasing-retention-in-veterinary-medicine/ white-paper-factors-that-support-retentionanddrive-attrition-in-the-veterinary-profession/?su bmissionGuid=421b9662-5807-4f97-aa0429b48f1342d9
22. The role-based approach targets
individual roles within practices, recognizing that different team
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APPLICATIONS OF REGENERATIVE MEDICINE IN VETERINARY HEMATOLOGY BY W. JEAN DODDS, DVM
How regenerative medicine and stem cell therapy are being increasingly utilized to enhance hematological knowledge in companion animals and treat related conditions in these species.
Regenerative medicine involves replenishing and utilizing the body’s undifferentiated stem cells, which then become specialized for replacing or repairing body tissues damaged by disease or injury. This article looks at how regenerative medicine is being used to enhance our knowledge of hematological issues in dogs, cats, and horses, and help treat a range of conditions in these species.
BIRTH AND DEVELOPMENT OF REGENERATIVE MEDICINE The benefits and clinical applications of medicinal therapies have been well-recognized for centuries, long before the term “regenerative medicine” came into common use.1 In fact, these medical developments and methods were pioneered by ancient civilizations in Mesopotamia, Egypt, China, India, and South America. The roots of this technology were anchored in the concept of epigenetic regeneration (modification of gene expression), as shown mostly in paintings depicting myths along with descriptions of the generation and regeneration of animals. The principles of regenerative medicine evolved from the historical milestones and scientific breakthroughs that occurred over subsequent generations, with more research being done in the 18th and 19th centuries.1
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Today, this scientific knowledge and the potential of regenerative medicine has rapidly expanded to restoring human health in an assertive, consistent manner.2-9 In 2023, the ability to grow red blood cells from the stem cells of healthy human donors in the laboratory initiated further in vitro research, with the first human trial being carried out in the UK.3
REGENERATIVE MEDICINE AND VETERINARY HEMATOLOGY Currently, this knowledge is being applied to laboratory research and companion animals, and is now involved at the forefront of health care for all species.3-13 In 2010, the North American Veterinary Regenerative Medicine Association (NAVRMA) was formed to encourage the development, training, and knowledge of veterinary regenerative medicine. This group remains fully active today, holding an annual conference and awarding training and travel grants for graduate students (navrma.org). Let’s review how this technology has been, and will continue to, apply to comparative and veterinary hematology:3,4,10,11,13-18 • Regenerative therapies that include mesenchymal stem cells, platelet-rich plasma, and autologous serum products are increasingly utilized in veterinary medicine for treating horses, dogs, and cats.4,8,9,13,18
• Veterinary regenerative medicine is an active area of research for developing new cell and tissue therapies for animals. These therapies act to “repair, replace, restore, and regenerate damaged or diseased tissues”.8,9,13-18 • A list of the number of commercially available bioscaffolds in 2021 appears in the appendix to footnote nine: tissue sources = collagen (6); extracellular matrix (ECM) (29); hyaluronic acid (HA) (7)9
CURRENT APPLICATIONS AND RESEARCH • In one study involving dogs, several transcription factors were used to forcibly reprogram somatic cells and turn them into induced pluripotent stem cells.4 Even after multiple cell passages, these new cell lines derived from canine peripheral mononuclear cells enriched with specific media, and a small molecule inhibitory factor maintained the karyotype of normal cells.4 Dogs share many diseases and environmental exposures with humans, making them an ideal translational species for comparative investigations, but canine somatic cell reprogramming has been fraught with problems of low efficiencies and incomplete pluripotency.15 Other factors such as cost, safety, and feasibility are potential roadblocks to the widespread clinical use of this technology for treating canine diseases. • In other research, earlier reprogramming into an embryonic stem cell-like state was done using mouse and human fibroblasts. Mice with induced humanized sickle cell anemia were subsequently shown to be rescued after transplantation with hematopoietic progenitors that provided gene-specific targeting.10 Application of this approach for treating affected mice needs to address issues with the use of retroviruses and oncogenes for the reprogramming, before it can be applied clinically to humans and companion animal species. Canine induced pluripotent stem cells have typically used fibroblasts for translational research in regenerative medicine, developmental biology, drug screening, and disease modeling.17 Newer technology with improved reprogramming efficiency used urine-derived cells that were reprogrammed under feeder-free conditions with a Sendai virus vector.17
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CONCERNS ABOUT STEM CELL THERAPY IN HUMANS WITH KOA
• In 2002, the veterinary company Vet Stem began development of its patented stem cell therapy using adipose-derived cells tissues in horses. Their first clinical treatment of a horse took place in 2004, and since then, more than 4,000 horses have been treated with their technology for bowed tendons, ligament injuries, and joint disease. In 2011, commercial treatment was extended to dogs and cats for osteoarthritis and soft tissue injuries. Over 14,000 animals have been treated with a very low reported adverse reaction rate (0.1-0.3%). Peerreviewed, double-blinded, placebo-controlled studies have been published, as well as retrospective and case studies for degenerative disorders. Vet Stem holds licenses to over 70 patents and has worldwide veterinary rights for use of adipose-derived stem cells.
Regenerative medicine is often applied for wound healing purposes using nano-scaffolds, 3D-printed surgical dressings, and biomaterials for chronic diseases and to promote tissue regeneration.5-9 However, these advances come with a warning about the potential toxic effects of nanoparticles.2 Further, a recent review of stem cell therapy for knee osteoarthritis (KOA) in humans was scathing.14 Fifty clinical studies and 13 systematic reviews/meta-analyses were included. The conclusions highlighted the inefficiency of stem cells, the risk of potential complications, and the limited quality of evidence, and stated that current study results “precluded any recommendation for using stem cell products in patients with KOA” and that “clinical translation of stem cell therapies remains baseless and should be cautiously approached until more robust evidence is available.”14
he many stated benefits of using adipose-derived T regenerative cells rather than those from bone marrow or allogeneic and autologous tissues include ready availability; greater numbers of stem cells than bone marrow; differentiation into multiple lineages for repair of bone, cartilage, and heart; and a heterogeneous mixture of regenerative cells (vetstem.com).
Dias-Ferreira J, Teixeira MC, Severino P, et al. Applications of biomaterials in wound healing management: from fundamental physiology to advanced technology. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar. In Nanotechnology and Regenerative Medicine, 2023, Ch. 13, 349-369. http://doi.org/10.1016/ B978-0-323-90471-1.00020-7. 6
• Similar equine mesenchymal stem cell studies were recently published in 2019 and 2020.13 Feline research for inflammatory bowel disease, asthma, kidney disease, and chronic gingivostomatitis was published by others in 2018, while canine research for osteoarthritis, osteochondritis, tendonitis, ligament rupture, fractures, and cartilage regeneration was reported in 2019.13 Also see celltherapytools.com. Clearly, these reported successes in animals contrast with the expressed concerns about human stem cell therapy for treating osteoarthritis (see sidebar).13,14
Soriano JL, Ríos M, López E, et al. Chapter 16 - Tissue engineering in wound healing. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar. In Nanotechnology and Regenerative Medicine, 2023, Ch. 16, 411-453. http://doi.org/10.1016/B978-0-323-90471-1.00017-7. 7
Londono R, Badylak SF. Biologic scaffolds for regenerative medicine: mechanisms of in vivo remodeling. Annals of Biomedical Engineering, 2015, 43(3),577-592. http://doi.org/10.1007/s10439-014-1103-8. 8
Dewey M, Badylak SF. A review of bioscaffolds for functional tissue repair. JAHVMA, 2021, 65 Winter, 37-47.
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Hanna J, Wernig M, Markoulaki S, et al. Treatment of sickle cell anemia mouse model with iPS cells generated from autologous skin. Science, 2007, 318(5858), 1920-1923. doi: 0.1126/science.1152092. 10
Garner S. Texas veterinarian saving anemic dogs through the use of stem cells. Stem cell therapy is a useful weapon in the fight against immune-mediated hemolytic anemia (IMHA). Vet Pract News, 2021, July 9, Digital Edition. 11
Manfiolli AO, Amaral R, Caliari-Oliveira C. Stem cells, organoids, and cellular therapy. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar. In Nanotechnology and Regenerative Medicine, 2023, Ch. 10, 233263. http://doi.org/10.1016/B978-0-323-90471-1.00003-7. 12
For additional information, see also ingeneron.com, ardenanimalhealth (formerly MediVet Biologics) and safarivet.com.
Baouche M, Ochota M, Locatelli Y, Mermillod P, et al. Mesenchymal stem cells: generalities and clinical significance in feline and canine medicine. Animals, 2023, 13, 1903-1917. http//:doi.org/10.3390/ani13121903. 13
Shang Z, Wanyan P, Zhang B, Wang M, et al. Review. A systematic review, umbrella review, and quality assessment on clinical translation of stem cell therapy for knee osteoarthritis: Are we there yet? Stem Cell Research & Therapy, 2023, 14, 91-107. http://doi.org/10.1186/s13287-023-03332-5. 14
Santana MHA, Huber SC. History and evolution of regenerative medicine. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar. In Nanotechnology and Regenerative Medicine, 2023, Ch. 2, 23-44. https://doi. org/10.1016/B978-0-323-90471-1.00011-6. 1
Formoso I, Shegokar R, Zielinska A, et al. Applications of nanotechnology in chronic diseases and tissue regeneration. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar. In Nanotechnology and Regenerative Medicine, 2023, Ch. 14, 507-527. http://doi.org/10.1016/B978-0-323-90471-1.00021-9. 2
Lawrence L. Lab-grown RBCs start long journey of discovery. AABB News, 2023, May; 12-15. www. aabb.org.
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Kimura K, Tsukamoto M, Tanaka M, et al. Efficient reprogramming of canine peripheral blood mononuclear cells into induced pluripotent stem cells. Stem Cells Dev. 2021 Jan 15; 30(2),79-90. doi:10.1089/scd.2020.0084.
Kuzma-Hunt AG, Shah V, DiMarco S, et al. Opening the “black box” underlying barriers to the use of canine induced pluripotent stem cells: a narrative review. Stem Cells Dev, 2023, 32(11-12), 2 Jun, 271-291. http:// doi.org/10.1089/scd.2022.0300. 15
Menzorov AG. Pluripotent stem cells of order Carnivora: technical perspective. Int J Mol Sci. 2023, Feb 15, 24(4), 3905. doi: 10.3390/ijms24043905. 16
Tsukamoto M, Kimura K, Yoshida T, Tanaka M, et al. Generation of canine induced pluripotent stem cells under feeder-free conditions using Sendai virus vector encoding six canine reprogramming factors. Stem Cell Reports 2024, 19, 141-157. http:.//doi.org/10.1016/j.stemcr.2023.11.010.
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Handa M, Soni M, Beg S, Shukla R. Nanoscaffolds and role of 3D-printed surgical dressings for wound healing application. Eds: Maria H. Santana, Eliana B. Souto, Ranjita Shegokar, In Nanotechnology and Regenerative Medicine, 2023, Ch. 14, 371-395. doi.org/10.1016/B978-0-323-90471-1.00021-9.
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Canine induced pluripotent stem cells open new frontiers in veterinary medicine. IVC Journal, 2024, Jan 8. https://ivcjournal.com/canine-induced-pluripotent-stem-cells-open-new-frontiers-in-veterinary-medicine.
In the news
AMERICAN BAR ASSOCIATION ADVOCATES FOR
NON-ANIMAL TESTING METHODS In a landmark move, the American Bar Association (ABA), representing the legal profession in the United States, has issued its first-ever statement on animal testing. It’s calling on governments to promote and incentivize the use of non-animal testing methods (NAMs). The ABA’s resolution, passed during its midyear meeting, underscores the significance of advancing humane and human-relevant ap-proaches in scientific research.
Central to the ABA’s resolution is recognition of the bipartisan Humane and Existing Alternatives in Research and Testing Sciences (HEARTS) Act (H.R. 1024, 118th Cong.). This legislation, aimed at addressing deficiencies in existing laws governing research proposals funded by the National Institutes of Health (NIH), is lauded as a crucial step towards promoting ethical and scientifically rigorous research practices.
As one of the lead co-authors of the information report and resolution, the ABA has highlighted the myriad benefits associated with the adoption and advancement of NAMs. These methods not only prioritize animal welfare but also drive innovation, safeguard the environment, and optimize taxpayer-funded research investments by ensuring the development of safer products and higher quality medicines.
The HEARTS Act, endorsed within the ABA’s report, embodies a balanced approach that advances scientific progress while simultaneously prioritizing human health, environmental protection, and the welfare of animals. Its inclusion in the ABA’s resolution serves as a testament to the ongoing scientific and ethical advancements aimed at phasing out the use of animals in research.
By championing NAMs and endorsing legislation like the HEARTS Act, fostering a culture of compassion and responsibility within the scientific community will become more plausible. Furthermore, this initiative aligns with broader societal trends towards greater awareness and concern for animal welfare and ethical research practices. The ABA’s call to action marks a significant milestone in the ongoing dialogue surrounding animal testing and research ethics. As stakeholders continue to collaborate and advocate for the widespread adoption of non-animal testing methods, the prospect of a future where scientific progress and ethical considerations coexist harmoniously grows ever closer. https://crueltyfreeinternational.org/latestnews-and-updates/american-bar-associationcalls-advancement-non-animal-researchand-testing
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Under construction: using bioengineered scaffolds to repair and replace canine tissue BY EMILY SINGLER, VMD
Advancements in small animal medicine closely follow those made in human medicine. At the same time, dog owners increasingly regard their canine companions as full-fledged members of the family. As a result, the demand for more advanced treatment options for dogs continues to grow. This has, in part, led to the exploration of novel treatments for conditions in which the growth of healthy new tissue or a replacement organ is desired. One such modality involves the creation of biological scaffolds upon which new tissue can grow inside the dog’s body. While still in the experimental stages, this type of regenerative medicine is unique in that the bioengineered scaffold is an interactive matrix that can nurture the growth of fully functional tissue in the very location where it is needed.
THE GOALS OF TISSUE ENGINEERING The use of bioengineered scaffolds, sometimes referred to as tissue engineering, relies on advances in the fields of cell biology, developmental biology, bioengineering, and biomaterial science to create new ways to promote healing in animals and humans. Nantavisai et al state that the goals of tissue engineering are to “restore, maintain, or improve function of the target tissue or organs.”1 Indications can include extensive wounds or fractures,
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malformed or poorly functioning tissue, and organ failure that requires complete replacement. In cases of severe tissue damage, or when an organ starts to fail, available treatment options have historically been limited to organ or tissue transplant, tissue grafting, and/or supportive treatment in hopes that the tissue in question will regenerate and/or heal on its own over time. These options have several limitations: tissue and organ transplantation is expensive, donor tissue/organs are not readily available, and transplanting carries the risk of rejection by the recipient’s immune system. Grafting is not always possible based on a wound’s size or location or the availability of suitable tissue to form a graft. Finally, supportive care is not always sufficient for the regeneration and healing of damaged or failing tissue. Efforts to introduce bioengineered tissue aim to address all these concerns.
THE BIOENGINEERED SCAFFOLD The bioengineered scaffold is meant to emulate the extracellular matrix (ECM) present in all organs and tissues. While acellular, the ECM is still rich in proteins such as collagen and elastin, proteoglycans including chondroitin sulfate, and signaling molecules (ligands) such as nerve growth factor, estrogen, and insulin. These components help provide growing tissue with
Just as stem cell therapy has gone from an experimental concept to an approved and commercially available treatment option for canine patients, bioengineered scaffolds will also likely become available as an advanced modality for dogs in need of tissue replacement.
structure, shape, and support for essential cellular functions.2 Because each tissue’s biological needs will vary, having a substrate on which to grow can help ensure the new tissue will develop the necessary functionality to integrate with other nearby tissues, and perform the required functions of that specific tissue or organ. Important functions of a bioengineered scaffold include supporting “cell adherence, spreading, proliferation, differentiation, maturation, and communication.”1
seeded with cells, usually stem cells from either the same animal or another one, that will grow to form the basis of the new tissue or organ. The recellularized scaffold is then implanted in the desired location in or on the body, where the cells can grow on the ECM in connection with the surrounding tissues. This allows for more complete incorporation of the new tissue into its target site, complete with the formation of blood vessels, lymphatic pathways, and innervation.1
A bioengineered scaffold is typically created by collecting a sample tissue from the type of tissue/organ being targeted from a donor animal or cadaver. In some studies, tissue derived from coral or algae has been used. This tissue must then go through a decellularization process, using a series of reagents and/or highpressure vacuum treatment; this removes any remaining cells from the tissue to prevent an immune response to the donor matrix in the recipient.1 Synthetic and hybrid (combination of natural tissue samples and synthetic substrates) are also sometimes used. Examples of synthetic scaffolds include ceramic, titanium, and polymers such as poly (lactic-co-glycolic acid) (PLGA). Bioengineered scaffolds and some synthetic scaffolds are termed “biodegradable” in the sense that they will eventually be broken down and/or remodeled as the new tissue grows in vivo.1,3
POTENTIAL APPLICATIONS IN THE TREATMENT OF DOGS
Once the scaffold is chosen and prepared, growth factors are added to support the growth of new cells. The scaffold is then
The use of bioengineered scaffolds for tissue regeneration has been explored as a treatment option for several disease states and injuries in canine patients. These include: • P eriodontal disease • D eep or otherwise complex skin wounds • B one reconstruction following trauma or tumor excision • T racheal collapse • B ladder and urethral reconstruction • C artilage reconstruction • R egeneration of small arteries.6-10 IVC Spring 2024
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THE ROLE OF STEM CELLS IN TISSUE REGENERATION
Stem cells can be particularly valuable in regenerative medicine because they are able to differentiate into many different types of cells based on the needs of the tissue or organ. Stem cells can be derived from many different parts of the body, and include: • Embryonic stem cells • Mesenchymal stem cells (MSCs), which can be further classified as: o A dipose-derived stem cells (ASCs) o Bone marrow-derived stem cells (BM-MSCs) o D ental tissue-derived stem cells (PDSCs).1 One research focus is to determine if certain types of stem cells yield better results than others. A study in which canine tracheal tissue was used as a scaffold demonstrated that the use of canine yolk sac (YS) cells to seed the scaffold resulted in the formation of blood vessels to keep the regenerated tissue alive and functioning.4 Another study, however, cited a concern that the use of embryonic stem cells might increase the risk of future tumor formation, and indicated a preference for mesenchymal stem cells to avoid this risk.1 The three most used types of mesenchymal stem cells — bone marrow-derived MSCs (BM-MSCs), adipose-derived MSCs (AD-SCs), and dental tissue-derived MSCs (DPSCs) — were compared for their advantages and disadvantages. While all three types are very capable of selfrenewal and multilineage differentiation, BM-MSCs and DPSCs were found to be much more difficult and/or invasive to collect and grow in vitro than ADSCs.1 Different studies reached varying conclusions as to whether BM-MSCs or AD-MSCs produced the best results in terms of new cell differentiation and tissue growth.1,5
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Experimentally bioengineered tissues and organs have also shown value in helping to screen new drugs for safety and efficacy, and thereby identify which drugs should be considered for development and approval.10 Research exploring additional applications for this technology, and to perfect its use so it can be practiced in the clinical setting, is ongoing. Several studies have looked at the use of bioengineered scaffolds in dogs both as a prototype for future treatment options in veterinary medicine, and as a model for possible treatment options in humans. At this time, these applications are still in the early experimental phases and not yet available as treatment options. Dall’Olio et al compared the use of decellularized and recelluarized skin bioscaffolds in the treatment of complex skin wounds in dogs. While they found the fastest healing occurred with the recellularized scaffolds, the decellularized scaffolds also yielded complete healing more quickly than control wounds left to heal by second intention.2 This may pave the way for an easier, less expensive tissue regeneration option for the treatment of skin wounds in dogs. Matias et al studied the feasibility of creating recellularized canine trachea scaffolds as a treatment option for patients diagnosed with severe tracheal stenosis and tracheal collapse. A bioengineered tracheal segment, they explain, would be superior to a transplanted segment due to concerns over the immune reaction to foreign tissue. There is also a need for tracheal tissue to retain its secretory and motility functions, and its segmental blood supply, all of which are more easily accomplished when the new tissue can integrate itself seamlessly with the existing tissue. This study did not go so far as to transplant the scaffolds into canine patients, but it measured the degree of immune response to the implantation of tracheal scaffolds in laboratory mice.4 Yun et al evaluated the success of AD-MSCs (see sidebar) for the treatment of large bone defects in dogs. The researchers created biodegradable synthetic scaffolds that they seeded with AD-MSCs from donor dogs. These scaffolds were then transplanted into small surgicallycreated femoral defects in laboratory beagles. The results
showed the stem cells could be induced to become osteogenic, and that the femoral defects treated with the seeded bioscaffold had significantly more bone growth in the defect. Conversely, the control group with no treatment filled more of the defect with fibrous tissue. Additionally, because the scaffold was biodegradeable, it did not need to be removed surgically after the bone defect had healed.5
As further research helps refine these technologies, it is almost certain that bioengineered replacement tissue will become a viable treatment option for both humans and animals. Important steps to accomplish this include continuing to elucidate the most effective scaffold materials and the best methods to support the growth of new tissue on the scaffold. Just as stem cell therapy has gone from an experimental concept to an approved and commercially available treatment option for companion animals, bioengineered replacement tissue will likely become available as an advanced modality for dogs and other animals in need of tissue replacement to improve their longevity and quality of life.
Nantavisai S, H Egusa, T Osathanon, and C Sawangmake. Mesenchymal stem cell-based bone tissue engineering for veterinary practice. Heliyon 5(2019) e02808. 1
Dall’Olio A, Matias G, Carreira A, Carvalho H, Campanella T, da Silva T, da Silva M, Abreu-Silva A, Miglino, M. Biological Graft as an Innovative Biomaterial for Complex Skin Wound Treatment in Dogs: A Preliminary Report. Materials 2022, 15,6027. 2
Qin J, Chen F, Wu P, Sun G. Recent Advances in Bioengineered Scaffolds for Cutaneous Wound Healing. Frontiers in Bioengineering and Biotechnology March 2022 (10) 841583. 3
Matias G, Carreira A, Batista V, de Carvalho H, Miglino M, Fratini, P. In vivo biocompatibility analysis of the recellularized canine tracheal scaffolds with canine epithelial and endothelial progenitor cells. Bioengineered 2022 (13) 2: 3551-3565. 4
Yun H, Kim S, Park S, Jo W, Kang K, Lee E, Kim D, Jung H, Son J, Park J, Park H, Lee S, Shin H, Hong I, Jeong K. Early Osteogenic-Induced Adipose-Derived Stem Cells and Canine Bone Regeneration Potential Analyzed Using Biodegradable Scaffolds. Bioengineering 2023, 10, 1311. 5
Baiguera S, Urbani L, Del Gaudio C. Tissue Engineered Scaffolds for an Effective Healing and Regeneration: Reviewing Orthotopic Studies. BioMed Research International 2014 Article ID 398069. 6
Carmagnola D, Tarce M, Dellavia C, Rimondini L, Varoni E. Engineered scaffolds and cell-based therapy for periodontal regeneration. J Appl Biomater Funct Mater 2017, 15(4); e303-e312. 7
Culenova M, Bakos D, Ziaran S, Bodnarova S, Varga I, Danisovic L. Bioengineered Scaffolds as Substitutes for Grafts for Urethra Reconstruction. Materials (Basel). 2019 Oct 22;12(20):3449. 8
Bousnaki M, Beketova A, Kontonasaki E. A Review of In Vivo and Clinical Studies Applying Scaffolds and Cell Sheet Technology for Periodontal Ligament Regeneration. Biomolecules. 2022; 12(3):435. 9
National Institutes of Health. Tissue Engineering and Regenerative Medicine. nibib.nih.gov/scienceeducation/science-topics/tissue-engineering-and-regenerative-medicine. Accessed February 10, 2024. 10
From the VMAA The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and auxiliary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.
ESSENTIAL OILS FOR TISSUE HEALING Human and animal bodies have an innate ability to repair and restore function after disease and trauma, and the chemical constituents of essential oils assist this process. Esters in essential oils are considered soothing and have sedating/anesthetizing properties. Their ketones offer analgesic and decongesting activities. The sesquiterpenes present in these oils have substantial anti-inflammatory actions, deliver oxygen to the cells, are analgesic and slightly bactericidal. Oils with a higher percentage of sesquiterpenes are more viscous. • H elichrysum (Helichrysum italicum) contains a combination of esters (75% neryl acetate), ketones (>20%), and the important sesquiterpene, beta-caryophyllene, thereby promoting tissue repair. Bruising often occurs with initial wounds and following surgery. Helichrysum helps to quickly resolve bruising from the TCM standpoint of dispelling stasis, regulating stagnant Qi, and moving blood. • M yrrh (Commiphora myrrha) contains >90% sesquiterpenes and is distilled from the resin of the myrrh tree. It will oxidize quickly when exposed to air and revert to its resinous state. Using myrrh topically can help create a BandAid-like effect. The TCM effects of myrrh are considered warming and drying. A combination of 50/50 helichrysum/myrrh is extremely helpful for pain. The accompanying photo shows the medial aspect of the RR pastern of a 24-year-old paint gelding with phythiosis. He would lie down and chew the area like a dog. Treatment consisted of surgical debridement, daily cleaning with an essential oil-infused shampoo, then a 50/50 combination of helichrysum/myrrh essential oil-infused ointment under a bandage. Resolution took over three months, but the gelding didn’t stop self-mutilating until the oils were used. References: Aromatherapy with Chinese Medicine (Willmont 2008) The Complete Guide to Aromatherapy (3rd edition) (Battaglia 2018) The Chemistry of Essential Oils Made Simple (Stewart 2005) Submitted by Susan Albright, DVM
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Essential oils for treating arthritis in dogs BY JARED MITCHELL, DVM, CVMA, CVA, CVFT
Arthritis is increasingly common in our canine patients. While conventional medications provide relief, they often have side effects. Essential oils are a holistic alternative that can be used alongside conventional treatments, or on their own.
Essential oils have been utilized for thousands of years. While their form may have changed thanks to advancing technologies such as distillation, their nature and ability to help treat pain and illness have remained a hallmark of aromatherapy treatment. As time has passed, they’ve also come into increasing use for companion animals. From everyday wellness routines to disease management, essential oils have found their way into modern veterinary medicine through their use by integrative and holistic veterinarians. One condition seen with increasing frequency in veterinary medicine is arthritis, with its multiple presentations and differing levels of pain. This article looks at how essential oils can provide an alternative treatment for managing arthritis in veterinary patients.
Osteoarthritis is characterized by a progressive deterioration of articular cartilage in diarthrodial joints, with hyaline cartilage thinning, joint effusion, and periarticular osteophyte formation.3 The clinical signs of arthritis can vary in severity and may include lameness, joint swelling, muscle atrophy, pericapsular fibrosis, and crepitation.1,3,4 Radiographic changes will also vary, depending on where the dog is along the timeline of arthritic progression. These changes can include joint effusion, periarticular soft tissue swelling, osteophytosis, subchondral bone sclerosis, and possibly narrowed joint space.1,3
A BRIEF REVIEW OF ARTHRITIS
Essential oils are concentrated lipophilic extracts of aromatic terpenoid constituents. In other words, they are volatile liquids distilled from certain parts of plants, including shrubs, flowers, trees, roots, bushes, and seeds.5,6 Essential oils are secondary metabolic end products of plant metabolism, and their functions include protection, nutrition, and reproduction.7 They consist of hundreds of chemical constituents that
Osteoarthritis is one of the most common conditions affecting dogs. In fact, up to 75% of medium to large-sized adult dogs may be affected.1 Scientific data has demonstrated that osteoarthritis in dogs is on the rise, with a 66% increase in just the past decade.2
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WHAT ARE ESSENTIAL OILS?
work synergistically, allowing them to display particular characteristics. These constituents are mixtures of different terpenes, sesquiterpenes, and aromatic compounds such as phenols and phenylpropanes.8 Essential oils can be utilized in several ways. The most commonly-used are diffusion, topical application, and oral administration. Of these, diffusion and topical applications are the most frequently prescribed. Because of the concentrated nature and potency of essential oils, it is vitally important to make sure only the purist and highest quality oils are used, especially when prescribing for our animal patients with their heightened sense of smell.
HOW ESSENTIAL OILS BENEFIT THE TREATMENT OF ARTHRITIS As discussed, essential oils contain bioactive constituents. Recent clinical studies have demonstrated that specific constituents are quite effective at decreasing inflammation and reducing pain to aid in the treatment of arthritis. Within specific studies, regarding inflammation and arthritis, certain constituents were found to inhibit the expression of IL-1β, TNF-α, and IL-6 in an inflamed synovial membrane. They were also shown to inhibit IL-1β and IL-6 in an inflamed meniscus.9 In another study, similar effects were demonstrated for Litsea cubeba, whose essential oil was able to decrease TNF-α,
Using essential oils in arthritis treatment:
IL-1β, IL-6, IL-8, and IL-17A levels and increase IL-10 in type II collagen-induced arthritic rats.10 Another important aspect of essential oil use in arthritis is pain reduction. Constituents such as monoterpenes and sesquiterpenes have been investigated for their potential antinociceptive activity and have demonstrated analgesiclike activity.9,11
a few tips to get started
•
Don’t worry if you do not have one of the oils outlined in this article. Many other essential oils have key constituents that will decrease inflammation and in turn help with some degree of pain control. Use what you have.
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You do not have to use all the oils. Find two or three that work best for you and your patients. Start with those and branch out from there.
•
When treating arthritic conditions, essential oils can be used singularly or combined into a blend.
•
Due to the highly concentrated nature of essential oils, it is always important to dilute them with a carrier oil, such as organic coconut oil, before topical use.
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When diffusing essential oils, use a diffuser with an automatic shutoff and always allow a way for the pet to leave the area where the oils are being diffused. This way, they can come and go as needed and avoid overexposure.
•
Multiple techniques can be utilized at once. For example, Copaiba could be applied topically to directly reduce pain and inflammation, while Lavender could be diffused to help calm and relax the pet.
•
Another important point is not to forget conventional veterinary training. While essential oils can often be used as a stand-alone treatment, they can also be incorporated into a conventional treatment plan. This integrative approach can be very beneficial for the patient, and over time, you may be able to decrease or even stop the conventional medications.
COMMON ESSENTIAL OILS FOR TREATING ARTHRITIS IN DOGS Copaiba (Copaifera officinalis) Copaiba is probably one of the most common and well-known essential oils for arthritis thanks to its antiinflammatory effects and ability to reduce pain. Copaiba essential oil is obtained from steam distillation of the oleoresin from the Copaiba tree. Its constituents are a complex mixture of terpenes known for their medicinal activities, including antimicrobial, antifungal, anti-parasitic, anti-inflammatory, anticancer, anxiolytic, mucolytic, and neuroprotective.12 A major, well-studied terpene in Copaiba is β-caryophyllene. It selectively binds to cannabinoid receptor 2 (CB2); activation of CB2 is a therapeutic strategy for the treatment of multiple medical conditions, including pain and inflammation.13 Because it is considered one of the top anti-inflammatory oils, Copaiba can often be utilized in place of nonsteroidal anti-inflammatory drugs (NSAIDs); alternatively, they can be given together to work more synergistically or until symptoms improve and the NSAID can be weaned down or stopped completely.14
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Case snapshot Snow is a four-year-old neutered male poodle who suffers from arthritic problems arising from injuries he sustained before being adopted. These injuries were so severe that his left rear leg was amputated and his right hind paw curves in slightly. Yet Snow is full of energy and enjoys running and playing. The injury has not slowed him down. Snow was initially on pain medications (Tramadol) and NSAIDs (Carprofen). When he was evaluated at our clinic, his owner expressed the desire to try and get him off the medications and try a more natural approach, yet she was concerned about doing acupuncture with everything he had been through. So we discussed using essential oils, as
Lemongrass (Cymbopogon flexusosus) The essential oil produced from Lemongrass is extracted by steam distillation from the dried or fresh leaves of the plant. The main constituents found in Lemongrass oil include myrcene, geranyl acetate, nerol, citronellal, geraniol, neral, and traces of lime and citrate.15 Its biological activity has been used to help treat a variety of medical conditions. Lemongrass essential oil has antifungal, antiinflammatory, antibacterial, and antiparasitic properties.16 As a more specific treatment for arthritis, it has been demonstrated to regenerate connective tissue and ligaments, improve circulation, and promote lymph flow.17 This essential oil is very popular for use with cruciate and muscle injuries.
this was something the owner could use at home. Snow was prescribed two drops of Copaiba, Frankincense, and Helichrysum added to five drops of coconut oil. This mixture was applied topically over the caudal spine, the right rear leg, and the amputation site of the left rear leg. The owner was
According to a 2005 study by Dr. Sue Chao, Lemongrass oil is one of the top six essential oils with anti-inflammatory properties. It is considered a “hot” oil and dilution is recommended for application.
Frankincense (Boswellia carterii)
instructed to apply this oil combination twice daily for seven days, take two days off, then repeat. Within a month, Snow’s owner reported she was no longer having to give him Tramadol, but was still giving him Carprofen. We continued the essential oil regimen for another month, at which point she told us she was only using the essential oil mixture and giving Snow Carprofen only when he
Frankincense is one of the most well-known essential oils, probably second only to lavender in recognition and popularity. This is due in part to its anti-cancer properties. Frankincense oil is a first choice in holistic and integrative cancer treatment protocols but there is more to it than its anti-tumoral effects. Its major constituents include alpha-pinene, limonene, sabinene, myrcene, beta-caryophyllene, alphathujene, and Incensole.18
“seemed extra tender and needed a little something”. About two months after this follow up, his owner reported that she doesn’t have to use anything for daily maintenance. She uses the essential oil mixture from time to time, but only if Snow seems to need it. The dog is doing well and living his best life free of medications, thanks to essential oils.
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Frankincense helps in the treatment of arthritis by affecting the physiological and metabolic pathways that lead to inflammation and pain. One study concluded that five bioactive compounds could help explain the reduction in inflammation.19 Another study set out to focus on specific pathways and concluded that the suppression of leukotriene synthesis by inhibition of 5-LOX is the main mechanism underlying the anti-inflammatory effect of boswellic acid.20
Helichrysum (Helichrysum italicum) Helichrysum essential oil is renowned for its powerful anti-inflammatory effects. Over the years, it has been known by other names such as Immortelle and Everlasting. Its main constituents include neryl acetate, gammacurcumene, alpha-pinene, beta-caryophyllene, and beta-selinene.21 Like many essential oils and holistic remedies, helichrysum tends to know what the body needs and can help restore balance and homeostasis. For example, it is used as an anticoagulant in cases where blood clots are present; but at the opposite end of the spectrum, it is very useful for helping to stop bleeding in cases of hemorrhage and bruising.22 When it comes to arthritis, Helichrysum is indicated for nerve regeneration, circulatory and blood vessel disorders, as a topical anesthetic, an anti-inflammatory agent, and for pain control.22,23,24 It is often included in pain recipe blends, especially those intended for oral use. In pain management situations, a synergistic effect has been noted when combining Helichrysum with Copaiba and Myrrh.22
Balsam Fir (Abies balsamea) Balsam Fir is also known as Fir Needle or Fir Balsam, and is commonly used for Christmas trees. Its chief constituents are alpha-pinene, beta-pinene, camphene, and limonene.25 Balsam Fir is great for use with arthritis and bone conditions, muscle and joint issues, and for decreasing inflammatory conditions.26,27 It has also been reported to assist in the treatment of scoliosis and sciatica.25
Marjoram (Origanum majorana) Marjoram has long been an important herb. It was known as the “herb of happiness” to the ancient Romans, and “joy of the mountains” to the Greeks. Today, Marjoram is also known as Sweet Marjoram. Some of its most common constituents include terpinen-4-ol, gamma-terpinene, linalol+cis4-thujanol, alpha-terpinene, alphaterpineol, and sabinene.28 Marjoram essential oil known as one of the “muscle” essential oils.29 It is also very beneficial for body and joint discomfort as well as muscle spasms, arthritis, and nerve pain.29,30
Myrrh (Commiphora myrrha) The essential oil of Myrrh is produced from the steam distillation of the tree’s gum or resin. Some of it major constituents include lindestrene, curzerene, furanoendesma-1,3-diene, 2-methoxy furanogermacrene, and beta-elemene.31 Bioactive constituents have been shown to help inhibit the expression of known inflammatory mediators such as IL-1β, IL-2, IL-10, IL-12, and TNFα.19 Myrrh is a very common essential oil used in pain management protocols. It is often combined with Copaiba and Helichrysum in an oral formulation.32 Myrrh is also an excellent choice for topical use to help control pain and promote post-surgical healing.
Lavender (Lavandula angustifolia) Perhaps no other essential oil is as wellknown and studied as Lavender. It is considered by many to be the “Swiss Army Knife” of essential oils. In other words, it is very versatile and can be utilized for most disease conditions. Lavender’s key constituents include linalyl acetate, linalol, cis-beta-ocimene,
trans-beta-ocimene, and terpinen-4-ol.33 In one clinical study, linalol and linalyl acetate accounted for the anti-inflammatory properties demonstrated in rats within the study.34 Other studies have shown that Lavender can be nociceptive because of its constituents’ ability to inhibit some of the major inflammatory mediators leading to severe pain.35,36 This makes Lavender an ideal choice for skin conditions, wound healing, muscular conditions, and arthritis.
Zhao J, Wang Q, Ma J. Chemical composition and anti-arthritic activity of the essential oil from Litsea cubeba against Type II collagen rheumatoid arthritis in rat collagen. Trop. J. Pharm. Res. 2020, 19, 645–650.
10
De Sousa, D.P. Analgesic-like activity of essential oils constituents. Molecules 2011, 16, 2233–2252
11
The Essential Oils Animal Desk Reference. Single Essential Oils: Copaiba. Life Science Publishing, May 2017. pp. 46-47.
12
Urasaki Y, Beaumont C, Workman M, Talbot JN, Hill DK, Le TT. Fast-Acting and Receptor-Mediated Regulation of Neuronal Signaling Pathways by Copaiba Essential Oil. Int J Mol Sci. 2020 Mar 25;21(7):2259. doi: 10.3390/ ijms21072259. PMID: 32218156; PMCID: PMC7177672.
13
Shelton M. Essential Oil Singles: Copaiba. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 241-244.
14
Devi BV, Devi RG, Priya AJ. Effect of lemongrass oil on body pain. Drug Invention Today. 2018 Oct 1;10(10).
15
SOME FINAL THOUGHTS
The Essential Oils Animal Desk Reference. Single Essential Oils: Lemongrass. Life Science Publishing, May 2017. p. 63.
16
Shelton M. Essential Oil Singles: Lemongrass. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 280-281.
17
Arthritis and degenerative joint diseases are becoming more prevalent within the canine population. While conventional treatment protocols have provided relief for many years, they are not without their side effects. Another consideration regarding long term medication use is that pets are becoming refractory to the treatments. Essential oils provide a holistic alternative that can be used alongside current treatments, or on their own. While eight of the most common essential oils used for treating arthritis are outlined above, there are many more that could be utilized in an arthritis treatment protocol. The key is to choose an organic, pure, high quality essential oil, and use it properly. If this is done, the benefits of essential oils for treating arthritis are amazing.
The Essential Oils Animal Desk Reference. Single Essential Oils: Frankincense. Life Science Publishing, May 2017. p. 53.
18
Su S, Duan J, Chen T, Huang X, Shang E, Yu L, Wei K, Zhu Y, Guo J, Guo S, Liu P, Qian D, Tang Y. Frankincense and myrrh suppress inflammation via regulation of the metabolic profiling and the MAPK signaling pathway. Sci Rep. 2015 Sep 2;5:13668. doi: 10.1038/srep13668. Erratum in: Sci Rep. 2015;5:15597. PMID: 26329643; PMCID: PMC4556964.
19
Al-Yasiry A, Kiczorowska B. Frankincense – therapeutic properties. Advances in Hygiene and Experimental Medicine. (2016);70(null):380-391. https://doi. org/10.5604/17322693.1200553.
20
The Essential Oils Animal Desk Reference. Single Essential Oils: Helichrysum. Life Science Publishing, May 2017. p. 56.
21
Shelton M. Essential Oil Singles: Helichrysum. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 267-270.
22
Tamilmani H, Devi RG. Effect of Helichrysum Oil on Arthritis. PalArch's Journal of Archaeology of Egypt/Egyptology. 2020 Nov 28;17(7):1981-5.
23
Akinyede KA, Cupido CN, Hughes GD, Oguntibeju OO, Ekpo OE. Medicinal Properties and In Vitro Biological Activities of Selected Helichrysum Species from South Africa: A Review. Plants. 2021; 10(8):1566. https://doi. org/10.3390/plants10081566.
24
The Essential Oils Animal Desk Reference. Single Essential Oils: Idaho Balsam fir. Life Science Publishing, May 2017. p. 58.
25
Shelton M. Essential Oil Singles: Balsam Fir. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 226-227.
26
Buchbauer G. Biological activities of essential oils. Handbook of essential oils: Science, technology, and applications. 2010 Oct 27:235-80.
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Millis D. Multimodal Pain Management for Canine Osteoarthritis. Today’s Veterinary Practice. Volume 11/Number 5. September/ October 2021. pp. 42-49.
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The Essential Oils Animal Desk Reference. Single Essential Oils: Marjoram. Life Science Publishing, May 2017. p. 65.
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Osteoarthritis in pets on the rise alongside obesity epidemic. Veterinary Practice News. June 25, 2019. Accessed February 3, 2024. veterinarypracticenews.com/ osteoarthritis-in-pets-on-the-rise-alongside-obesity-epidemic.
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Shelton M. Essential Oil Singles: Marjoram. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 283-284.
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H arari J. Degenerative Arthritis in Dogs and Cats. Found in the Merck Veterinary Manual online. merckvetmanual. com/musculoskeletal-system/arthropathies-and-related-disorders-in-small-animals/degenerative-arthritisin-dogs-and-cats?query=degenerative%20joint%20disease%20in%20dogs. Last Accessed on February 5, 2024.
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Sorah E. Carprofen for Dogs: Osteoarthritis and Pain Management. Today’s Veterinary Practice. Volume 10/ Number 4. July/August 2020. pp. 68-72.
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3
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Shelton M. Essential oils to maximize health. Innovative Veterinary Care Journal. February 14, 2017.
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Muqaddas RA, Nadeem F, Jilani MI. Essential chemical constituents and medicinal uses of Marjoram (Origanum majorana L.)–A comprehensive review. International Journal of Chemical and Biochemical Sciences. 2016;9:56-62. The Essential Oils Animal Desk Reference. Single Essential Oils: Myrrh. Life Science Publishing, May 2017. p. 68. Shelton M. Essential Oil Singles: Myrrh. The Essential Oils Animal Desk Reference, 2nd ed. 2018. pp. 291-294.
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The Essential Oils Animal Desk Reference. Single Essential Oils: Lavender. Life Science Publishing, May 2017. p. 61-62.
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Young, D. Gary. Chapter 1: Essential Oils: The Missing Link in Modern Medicine. Essential Oils Integrative Medical Guide, Life Science Publishing, 2003.
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Schnaubelt K. Chapter 2: The Bioactivity of Essential Oils. The Healing Intelligence of Essential Oils. Healing Arts Press. Rochester, Vermont. 2011. pp. 29-44.
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S chnaubelt K. Chapter 2; Essential Oils – Definition and Distillation. Sections: The Composition of Essential Oils and The Spectrum of Action of Essential Oil Components. Advanced Aromatherapy: The Science of Essential Oil Therapy. Healing Arts Press. Rochester, Vermont. 1995. pp. 19-30.
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arrelli M, Amodeo V, Perri MR, Conforti F, Statti G. Essential Oils and Bioactive Components against Arthritis: M A Novel Perspective on Their Therapeutic Potential. Plants (Basel). 2020 Sep 23;9(10):1252. doi: 10.3390/ plants9101252. PMID: 32977657; PMCID: PMC7598204.
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Peana AT, D'Aquila PS, Panin F, Serra G, Pippia P, Moretti MD. 2002. Anti-inflammatory activity of linalool and linalyl acetate constituents of essential oils. Phytomedicine 9: 721-726. Peana AT, Marzocco S, Popolo A, Pinto A. 2006. Linalol inhibits in vitro NO formation: Probable involvement in the anti-nociceptive activity of this monoterprne coumpond. Life Sci 78: 719-723. Silva GL, Luft C, Lunardelli A, Amaral RH, Melo DA, Donadio MV, Nunes FB, de Azambuja MS, Santana JC, Moraes CM, Mello RO, Cassel E, Pereira MA, de Oliveira JR. Antioxidant, analgesic and anti-inflammatory effects of lavender essential oil. An Acad Bras Cienc. 2015 Aug;87(2 Suppl):1397-408. doi: 10.1590/00013765201520150056. Epub 2015 Aug 4. PMID: 26247152.
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industry innovations Nutritionally balanced plant-based dog food Do you have clients who want to feed their dogs a plant-based diet? A great choice is Earth Animal’s Wisdom Air-Dried From the Seed recipe. It’s formulated from plant-based proteins, including lentil protein, sunflower seed protein and alfalfa protein, and also contains Omega-3 fatty acids, ancient grains, fruits and vegetables, and sprouted seeds for a 100% complete and balanced food. The ingredients are gently air-dried to retain vital nutrients and flavor. earthanimal.com
Make tooth-brushing safer We know how important it is for our clients to take care of their dogs’ dental health in between clinic visits. However, compliance can be an issue if a dog doesn’t cooperate with having her teeth brushed. The BiteBlock from PawReady enables your clients to brush their dogs’ teeth without worrying about being bitten. Available in three sizes, it’s made of natural rubber that protects fingers and the dog’s gums during brushing. pawready.com
Gentle pH-balanced eye wash Project Watson Eye Wash is formulated to target and clean dogs’ eyes with a gentle, pH-balanced formula that helps keep eyes free of the dirt and buildup that can cause infection. Made with naturally inspired, high quality ingredients, such as sodium, a component of natural tears, the eye wash is designed to match the pH of a dog’s eye and help remove dried mucous, foreign materials, pollen and other irritants. bausch.com/products/dog-care/
Get the right diagnosis for GI problems Diagnosing GI issues in pets can be challenging because so many factors are at play. No single test covers all the potential causes, whether they include IBD, pancreatitis, etc. VDI Lab’s Advanced GI Panel is a unique array of tests that identifies a patient’s problem with a single blood panel. Because all it entails is a simple blood draw, it’s a non-invasive and cost-effective method to get to the root of GI issues. vdilab.com/advanced-gi-panel/
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Chiropractic care for aging dogs:
PROMOTING
MOBILITY BY JUDY MORGAN, DVM, CVA, CVCP, CVFT
Chiropractic care is an effective diagnostic and therapeutic modality for identifying and treating primary causes of musculoskeletal dysfunction in dogs.
Geriatric animals account for half of the pet population in the United States, and their numbers are increasing annually.1 Mobility limitations significantly decrease quality of life and shorten life expectancy for senior dogs. Dogs lacking mobility are predisposed to unwanted sequela, including decubital sores, urinary tract infections, skin infections, and pneumonia. Therefore, a major goal in optimizing geriatric health is to improve functional movement. Chiropractic care is one way to promote and support mobility in senior dogs.
Veterinary spinal manipulation therapy should be performed by a veterinarian trained in this modality. Many human chiropractors also perform spinal manipulations on animals and may be certified by the Animal Chiropractic Certification Commission. Animal chiropractors need to have specific training in both chiropractic technique and animal anatomy so they know the differences among species and how to best adjust the vertebrae.2
VETERINARY SPINAL MANIPULATION THERAPY
CHIROPRACTIC EXAM AND ADJUSTMENTS
For centuries, spinal manipulation has been used in humans as a therapy to complement traditional medicine. Although not universally accepted as a standard treatment for dogs, chiropractic therapy is gaining more acceptance. The modern form of animal chiropractic became popular within the past century, and has been dubbed “veterinary spinal manipulation therapy”. The American Veterinary Chiropractic Association (AVCA) was founded in 1989.
The chiropractic exam offers additional diagnostic and therapeutic means of identifying and treating primary causes of musculoskeletal disorders, compared to more traditional veterinary clinical approaches alone. It includes evaluating the patient’s history, intended use, athleticism, and health status, along with a neurological examination, stance and gait analysis, radiographs, and motion and static palpation.
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Chiropractic adjustment is defined as short lever, high velocity, controlled thrust by hand or instrument directed at specific articulations to correct vertebral subluxations.3 When performed by a qualified practitioner, veterinary spinal manipulation has a lower incidence of injury or adverse reactions than many standard treatments or medications. Subluxation occurs when the vertebrae are in abnormal positions or misaligned, resulting in altered physiologic functions of the spine and placing excessive pressure and inflammation on the spinal nerves. Left untreated, subluxation can trigger a degenerative process in the surrounding areas, including degenerative joint changes. Subluxations commonly occur due to traumatic events, poor conformation, lack of movement, overwork, or genetic boney issues. Loss of muscle tone due to aging or arthritis pain decreases the ability of the muscles to keep the spine aligned.
The symptoms of subluxations are varied. They can include chronic pain, swelling, limited mobility, unwillingness to move, irritation or aggression, trouble climbing stairs, limping, weakness, inability to jump, sitting in an abnormal position or tilted to the side, abnormal gait with shortened stride, hunched back, or crying. Other changes can include digestive and bowel issues, dragging feet, incontinence (both bowel and bladder), muscle atrophy, pockets of congestion where toxins build up in muscles, edema or fluid retention, fibrosis or scar tissue in the muscles, blood pooling in the muscles from decreased blood circulation, lack of blood flow to muscles due to spasms, minute hemorrhages, and tissue rigidity.
Emotional stress and chemical imbalances also contribute to spinal subluxations. Prescription drugs can have a negative impact on muscle and muscle tone. Calcium-deficient diets can be associated with muscle spasms that can impact spinal alignment. Environmental and food toxins cause chemical imbalances in the body that affect muscles and spinal alignment. Five components create the spinal vertebral subluxation complex:
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Osseous component: This is where the vertebrae are
either slightly out of position, not moving correctly, or undergoing degeneration.
2. Nerve component: Improper spinal function irritates nerve tissue, causing symptoms in various parts of the body depending on the nerve affected.
3. Muscle component: When the muscles supporting the spine tighten, weaken, go into spasm, or suffer from atrophy, a change in muscle tone results.
4. Soft tissue component: Changes occur in the surrounding soft tissues, such as the tendons, ligaments, and blood supply when vertebrae are misaligned and there’s pressure on the nerves.
5. Chemical component: Biochemical abnormalities will occur in organs and tissues depending on which area of the body is being affected by the spinal misalignment.4
CHIROPRACTIC CARE FOR PREVENTION Proactively performing veterinary spinal manipulation as dogs get older can help prevent or prolong the development of problems. A 2021 Norwegian study by Halle and Granhus7 evaluated veterinary chiropractic treatment as a way to prevent spondylosis in Boxers. Seventeen litters of Boxer puppies were divided into two groups, with half receiving monthly chiropractic care from eight to 52 weeks of age. The frequency of spondylosis was significantly lower in the dogs receiving chiropractic care (25% vs. 46.5%). Spondylosis affects about 50% of Boxers by six years of age, which correlates with the untreated puppies in this study. IVC Spring 2024
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ADDITIONAL CONSIDERATIONS Obesity, loss of muscle mass, and a sedentary lifestyle contribute to age-related comorbidities. •
Regular exercise is crucial for all dogs, including seniors. Even though a dog may have osteoarthritis, degenerative joint disease, or other joint disorders, it is critical to maintain as much muscle mass as possible. Low-impact physical activity such as swimming, underwater treadmill exercises, balance balls, and core-strengthening activities can help maintain and improve muscle mass and stability. Using a harness instead of a collar can reduce pressure on the neck.
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HOW CHIROPRACTIC ADJUSTMENT HELPS SENIOR DOGS Chiropractic adjustment can be beneficial for senior dogs with: •
Hip dysplasia
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Osteoarthritis
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Intervertebral disc disease
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Degenerative myelopathy
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Spondylosis
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Cruciate tears
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Any inflammatory or degenerative condition.
The goal of chiropractic treatment is to restore normal joint mobility, improve flexibility, and reduce pain and muscle tension. Ensuring normal range of motion of the vertebrae can increase the function of the lymphatic and circulatory systems and help clear toxins from the body. This therapy can be very useful in alleviating pain caused by chronic disease.
RESTORING NERVE FUNCTION
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Weight management must be at the forefront of health considerations for senior dogs, since excess weight puts unnecessary pressure on the spine, neck, and joints. Obesity decreases longevity and increases morbidity in dogs. Feeding a species-appropriate, low-carbohydrate diet makes it easier to maintain lean muscle mass. Diets richer in protein may also help ameliorate the effects of muscle atrophy.5 It has been proposed that geriatric dogs have a higher protein turnover than young adults, and therefore require more protein to help maintain muscle.6 It is important to maintain a high quality and quantity of protein in the diet, especially for dogs on weight loss plans. IVC Spring 2024
At every vertebral space, nerves exit and enter the spinal column. The nerves carry impulses from the brain to the internal organs, muscles, joints, and skin, and transmit information from all areas of the body back to the brain. When the vertebral joints do not have a full range of motion, the nerves become irritated. The chiropractor’s job is to detect those areas that have lost motion. A chiropractic adjustment restores mobility and allows the nerve impulses to transmit freely. A chiropractor moves through each joint, restoring the range of motion, allowing the nervous system to function at full capacity. The chiropractor will work on all spinal joints, as well as joints in other areas of the body, relieving tension on the nerves and increasing blood supply to the area.
THE RESULTS OF CHIROPRACTIC ADJUSTMENT Following an adjustment, geriatric dogs usually seem less stiff and painful. They may show improvements in gait, activity, and stamina. While some may show improvement immediately after an adjustment, others may take days or weeks, depending on the severity and length of time the subluxations have been present. Other problems associated with aging may also resolve after chiropractic care,
including urinary and fecal incontinence, nervous licking and chewing, lick granulomas, and behavioral issues such as agitation and aggression. Animal chiropractic offers the veterinary profession a cost-effective diagnostic and therapeutic means of identifying and treating primary causes of musculoskeletal dysfunction and suboptimal health and performance. Applied correctly, chiropractic adjustments can alleviate or eliminate the need for long-term drug or hormone treatments. The success of treatment depends on the degree of pathology present and the duration of the condition. Senior dogs have everything to gain and nothing to lose by receiving veterinary spinal manipulation.
1 Frye C, Carr BJ, Lenfest M, et al. Canine Geriatric Rehabilitation: Considerations and Strategies for Assessment, Functional Scoring, and Follow Up. Front Vet Sci. 2022; 9:842458. 2 American Veterinary Chiropractic Association, animalchiropractic.org/. Accessed Feb 3, 2024. 3 National Center for Complementary and Integrative Health. Spinal Manipulation: What You Need to Know. Available at nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know. Accessed Feb 3, 2024. 4 Chiro Care Florida. What is a Subluxation? Causes, Symptoms & Treatment. Available at https:// chirocareflorida.com/what-is-subluxation/. Accessed Feb 3, 2024. 5 Laflamme DP. Nutritional Care for Aging Cats and Dogs. Vet Clin North Am Small Anim Pract. (2012) 42:769-91. 6 Wannemacher RW Jr, McCoy JR. Determination of optimal dietary protein requirements of young and old dogs. J Nutr. (1966) 88:66-74. 7 Halle KS, Granhus A. Veterinary Chiropractic Treatment as a Measure to Prevent the Occurrence of Spondylosis in Boxers. Vet Sci (2021) Sep; 8(9):199.
From the IVAS The mission of the International Veterinary Acupuncture Society (IVAS) is to provide, promote and support veterinary acupuncture and related treatment modalities through quality basic, advanced and continuing education, internationally recognized certification for veterinarians, and responsible research.
Acupuncture is one of the most noninvasive and cost-effective tools available to enhance healing and facilitate regeneration. It has been shown to improve circulation, balance parasympathetic and sympathetic outflow, and modulate the immune system. From a Traditional Chinese Medicine (TCM) standpoint, acupuncture can influence the movement of Qi and Blood, improving circulation and bringing nutritive substances to areas that are compromised, undernourished, or Stagnant. By releasing tension in soft tissues such as fascia and muscle, acupuncture can help normalize movement and posture, reducing the negative effects of aging and impact on the joints and spine. Many medical conditions can be improved with acupuncture and associated modalities. Arthritis with muscle atrophy is one of the most common cases in everyday veterinary medicine that can be improved with acupuncture. Choosing acupoints to resolve Stagnation (relieve tension and pain) and support the Zheng Qi (overall immune and healing capacity), will improve comfort and nourishment of the joints and muscles. Acupuncture can work synergistically with other modalities to stimulate cell and tissue regeneration. If you’re not acupuncture certified and would like to learn more about adding it to your practice, check out the upcoming acupuncture courses offered through IVAS. If you are currently practicing acupuncture, consider joining us in Scotland at our Annual Congress in September to find out what is new and cutting edge in the acupuncture world! For more information, visit ivas.org.
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BY OMER RASHID, DVM
App development for veterinary practitioners Developing custom veterinary apps offers a valuable opportunity to improve and streamline your practice, elevate patient care, and foster stronger connections with clients. In today's digital age, mobile applications have become invaluable tools for businesses across various industries, including veterinary practice. These apps offer a range of functions that can streamline processes, improve communication, and enhance the overall efficiency of veterinary clinics and professionals. Many veterinarians are recognizing the significance of mobile apps in modern veterinary practice, and are exploring the development of custom applications tailored to their specific needs and requirements. This article looks at how you can do the same.
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and streamlining administrative processes, custom veterinary apps can significantly improve practice efficiency. From managing patient records and inventory to processing payments and generating reports, these apps enable veterinarians to save time, reduce errors, and focus on delivering high quality care. •
ccess to educational resources: Veterinary apps can A serve as valuable educational tools for both professionals and pet owners. Including features such as medical reference guides, training videos, and informational articles means custom apps can empower users with knowledge and resources to make informed decisions about animal health and wellness.
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elemedicine capabilities: In an era of increasing demand T for telemedicine services, custom veterinary apps can facilitate remote consultations and virtual care delivery. Through secure video conferencing, messaging, and image sharing functions, veterinarians can provide timely advice, diagnosis, and treatment recommendations to clients, regardless of their location.
IMPORTANCE OF MOBILE APPS IN VETERINARY PRACTICE Mobile apps have revolutionized the way veterinary professionals manage their clinics, interact with clients, and provide care to their animal patients. With the widespread use of smartphones and tablets, these apps offer unparalleled convenience and accessibility, allowing veterinarians to stay connected and productive, even while on the go. From appointment scheduling and medical record management to educational resources and telemedicine capabilities, mobile apps play a crucial role in modernizing and optimizing veterinary services.
BENEFITS OF DEVELOPING CUSTOM VETERINARY APPS •
Personalized solutions: Custom veterinary apps can be tailored to meet the unique needs and workflows of individual clinics and practitioners. By developing a custom app, veterinarians can create a solution that aligns perfectly with their practice goals, preferences, and specialty areas.
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Enhanced practice efficiency: By automating routine tasks
UNDERSTANDING THE NEEDS OF THE VETERINARY PRACTICE Before diving into the development process, it’s crucial to have a clear understanding of the needs and requirements of the veterinary practice. This involves identifying the target audience, assessing the specific challenges faced by veterinarians, and researching existing apps to gather insights into their functions and features.
1. IDENTIFYING THE TARGET AUDIENCE
Improved client engagement: Mobile apps provide a
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direct and convenient channel for communication between veterinarians and their clients. Through features such as appointment booking, reminders, and real-time messaging, custom apps can enhance client engagement, foster stronger relationships, and encourage proactive pet care.
The primary audience for the app includes veterinarians, veterinary technicians, and other staff members involved in animal care and practice management.
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Depending on the app’s purpose, pet owners may also be a target audience. Consider their preferences, expectations, and pain points when designing the app.
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2. ASSESSING SPECIFIC NEEDS AND CHALLENGES • •
Streamlining the appointment scheduling process to minimize wait times and optimize clinic workflow Developing a secure and user-friendly system for storing, accessing, and updating patient medical records
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Enhancing communication channels between veterinarians and clients to provide timely updates, reminders, and educational resources
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Implementing tools for tracking inventory levels, ordering supplies, and managing medications and equipment
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Introducing telemedicine capabilities to facilitate virtual consultations and remote monitoring of patients.
PLANNING AND CONCEPTUALIZATION Once the needs and requirements of the practice have been identified, the next step is to plan and conceptualize the app. This phase involves defining the goals and objectives, creating a detailed feature list, and developing a rough prototype to visualize the app’s functions and user interface.
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Gather input from veterinary professionals and potential users to ensure the feature list aligns with their preferences, workflows, and pain points.
3. CHOOSING DEVELOPMENT PLATFORMS AND TOOLS After establishing the goals and features of the veterinary app, the next step is to select the appropriate development platforms and tools. This involves evaluating different options for app development, choosing the right technologies, and deciding between app-building platforms or custom development. Consider the target audience and market share when deciding between iOS and Android platforms. Evaluate factors such as device compatibility, user demographics, and revenue models (App Store vs. Google Play). Explore cross-platform frameworks like React Native, Flutter, or Xamarin, which allow developers to write code once and deploy it across multiple platforms. Assess the trade-offs in terms of performance, native capabilities, and development complexity. Assess the feasibility of using app-building platforms or app generators, which offer drag-and-drop interfaces and pre-built templates for rapid app development. Evaluate the benefits of custom development for greater control over the app’s design,
1. DEFINING THE APP’S GOALS AND OBJECTIVES •
Clear purpose: Clearly define the primary purpose of the app, whether it's to streamline clinic operations, improve client communication, or enhance patient care.
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Specific objectives: Establish the specific objectives the app aims to achieve, such as increasing appointment bookings, reducing administrative tasks, or enhancing diagnostic capabilities.
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Measurable outcomes: Identify key performance indicators (KPIs) to measure the app’s success, such as user engagement metrics, efficiency improvements, or revenue growth.
2. CREATING A DETAILED FEATURE LIST BASED ON NEEDS •
Compile a list of essential features based on the identified needs and challenges as outlined above. This may include appointment scheduling, medical records management, client communication tools, and telemedicine capabilities.
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Prioritize features based on their importance and impact on achieving the app’s goals and objectives. Consider categorizing features into must-have, nice-to-have, and future development phases. IVC Spring 2024
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functionality, and performance. Consider factors such as cost, flexibility, and customization options.
4. DESIGNING THE USER INTERFACE (UI) AND USER EXPERIENCE (UX) Once the development platforms and tools are chosen, the focus shifts to designing the user interface (UI) and user experience (UX) of the veterinary app. This stage involves creating an intuitive, visually appealing interface that enhances usability and ensures a positive experience for users. It’s important to create an intuitive and user-friendly interface. Incorporating branding elements and visual identity is also a valuable part of the app development process. You also need to focus on accessibility and ease of navigation.
5. DEVELOPMENT AND TESTING With the design phase complete, the focus shifts to the development and testing of the veterinary app. This phase includes processes such as coding and programming the app features by employing frontend development, backend development, and integration of different features. This is followed by conducting rigorous testing for functionality, usability, and performance, and then iterative development based on user feedback and testing results.
6. INTEGRATION WITH VETERINARY SYSTEMS AND APIS Once the development and testing phases are complete, the next step is to seamlessly integrate the veterinary app with existing management systems, implementing secure data transfer and storage protocols, and leveraging APIs for additional functionalities and data sources.
7. DEPLOYMENT AND DISTRIBUTION After the development phase, the deployment and distribution of the veterinary app are crucial to make it accessible to users and maximize its reach and impact. Publishing on app stores such as Apple App Store and Google Play Store is an important step to making the app available online. Next comes implementing effective marketing strategies for app promotion, which includes targeted advertising; forging strategic partnerships with veterinary clinics, pet care organizations, industry influencers, and professional associations to promote the app to their networks and communities; and collaborating on joint marketing initiatives, sponsorships, or co-branded promotions to increase visibility and credibility. App Store Optimization (ASO) is another important part of making sure your app has maximum exposure. And finally, providing ongoing support and updates for the app can make you stay ahead of your competitors.
FINAL WORDS The development of custom veterinary apps presents a valuable opportunity to drive positive outcomes, elevate patient care, and foster stronger connections with pet owners. The nitty-gritty of app development can, of course, be handled by app developers but having some know-how of the process will come in handy. By embracing technology as a catalyst for innovation and improvement, veterinarians can lead the way towards a future of enhanced veterinary care and practice excellence.
Monitoring and analytics It’s crucial for veterinarians to recognize that app development is not a one-time endeavor but an ongoing process. Regular maintenance and updates are essential to address evolving user needs, technological advancements, and regulatory requirements. Continuous monitoring and analysis of app performance metrics and user feedback are vital for optimizing the veterinary app and ensuring its effectiveness in meeting user needs. Gauging downloads, engagement, user retention, user feedback and behavior can help you improve your app. 38
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Regulatory compliance and security Ensuring regulatory compliance and implementing robust security measures are paramount considerations in the development of veterinary apps, in order to protect user data and maintain trust among stakeholders. It’s also important to obtain necessary certifications or approvals.
In the news
Breakthrough Treatment for FIP Utilizes Human COVID-19 Drug In a groundbreaking development, veterinarians in the United States are turning to an unexpected source for the treatment of feline infectious peritonitis (FIP), a lethal disease affecting cats. They’re using the antiviral drug Remdesivir, initially approved for COVID-19 treatment in humans. FIP is a rare but devastating response to infection by the feline enteric coronavirus (FECV). It typically proves fatal due to severe inflammation caused by viral mutations. FIP predominantly affects young cats, and without intervention, afflicted animals often succumb to the illness within a matter of months, weeks, or even days after symptoms manifest. The rarity of FIP has long posed challenges for veterinarians, and these challenges are compounded by the lack of effective treatments available in the United States. Previously, cat owners resorted to acquiring illegal imports of
antiviral drugs through black market channels to address the dire needs of their afflicted feline companions. More recently, however, Dr. Anna Reading, a small animal practitioner based in southern Washington state, in collaboration with veterinary colleagues and personal connections, made a breakthrough in FIP treatment. She made headlines by successfully administering Remdesivir (marketed as Veklury by Gilead Sciences for COVID-19 therapy) to a cat suffering from FIP, all within the confines of existing laws and regulations, thereby offering a glimmer of hope for cats battling this fatal disease.
Nevertheless, challenges persist, with many veterinarians still unaware of the option of using Remdesivir for FIP treatment, and others facing hurdles in obtaining the drug for their patients. Despite these obstacles, Dr. Reading’s pioneering efforts underscore the potential of repurposing existing medications to address previously unmet needs in veterinary medicine. Her success serves as a beacon of innovation and resilience, inspiring hope for improved outcomes for cats facing FIP and other life-threatening diseases. https://news.vin.com/default.aspx?pid= 210&Id=11910939&sx=236031314& n=5&f5=1
The emergence of a legal and viable treatment option for FIP signifies a significant stride forward in feline medicine, offering renewed optimism for both veterinarians and pet owners grappling with the devastating impact of the disease.
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My top 5 lessons from clinical veterinary practice BY MELISSA L. MAGNUSON, DVM
A career as a veterinarian involves continuous learning as well as personal and professional growth. Along with growing your knowledge base and building up your confidence, it will also humble you more times than you can count.
After graduating from veterinary school in 1998, I started clinical practice in an intern setting. I worked 120 hours per week in exchange for a small salary and a place to live. I was very fortunate to have stellar mentorship, an incredible opportunity to see many sick pets (emergency setting), and the bravery to ask for help. My internship year set the groundwork for my career. Now, 26 years later, I have learned many more lessons, all of them important to shaping the veterinarian I have become. I’ll share those lessons in this article.
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LEARN TO LOVE THE JOURNEY: YOUR CLIENTS AND PATIENTS ARE YOUR BEST TEACHERS.
The first and foremost lesson is to embrace your clients’ feedback, because they are the voice of their pets. Animals can’t talk and communicate the way humans can. Their owners are with them every single day, so their input is vital.
Case example My most valuable lesson came from a young man with a one-year-old female Akita. I was working a Saturday shift when he came into the ER. He was very nervous, almost crying, and panicking about his dog. The dog was acting normal and had normal physical exam findings. I explained this to him and he disagreed with me vehemently and told me something very serious was going on as his dog was not “acting normal” at all.
In the back of my head, I thought he was overreacting and being dramatic, but he begged me to perform diagnostic tests, so I did. As soon as the radiographs were displayed, I saw the problem. The dog’s intestines were severely dilated with gas — she had an intestinal torsion. We immediately took her to surgery, where we found that she had a splenic torsion as well as an intestinal torsion, and she also had a tennis ball in her stomach.
and take care of others. If you go to work with an empty bucket, you will quickly become overwhelmed and let impostor syndrome take over. Learning to love yourself, doing self-work, and knowing what you are really good at it and what you need to develop, are all very important. Establishing self-awareness and responsibility for all your actions is key to building the foundation of confidence so necessary in this career.
The dog survived, and in fact did very well, thanks to her loyal owner knowing something was very wrong. Most intestinal torsion cases die before they even make it to ER. This lesson taught me to trust the client, even if they seem a little crazy or hypervigilant. Looking back, I am glad this young man was so dramatic.
Once you have built a foundation of awareness and confidence, you can set boundaries to relay to clients. You are a veterinarian, and “practice” veterinary medicine. This is not accounting — we are not looking for any final number. We treat patients: 50% of what we do is on us, the other 50% is how the pet responds and how compliant the owner is. We have no control over the latter. Will the dog react adversely to the medication? Will he allow it to be administered when it is supposed to be? Many variables are out of our control. We cannot magically make pets better.
Patients teach me lessons as well. Reading journals, going to continuing education, and consulting with other veterinarians has certainly provided a wealth of information, but feedback from my patients is absolutely priceless. Animals give us this feedback if we are willing to listen. Being impeccable with your physical exam skills, and paying attention to how animals communicate back to us is invaluable. For example, a bouncy Chocolate Lab that is panting and twirling around the exam room, but becomes very somber when his abdomen is palpated, tells me something is not normal. Or a cat who is typically fractious but suddenly becomes docile and amenable to handling tells me there’s serious disease going on. Paying attention to simple animal cues can direct you along your medical sleuthing path.
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BE CONFIDENT AND BE YOUR AUTHENTIC SELF: YOU ARE A PRACTICING VETERINARIAN, NOT A MAGICIAN, BANKER OR THERAPIST.
Case example I recently performed surgery on a dog’s ear, but the site was not healing well. The owners reported that their dog was going outside with the e-collar on and was scooping up snow into the collar, which meant the incision was getting very wet. The owners had not been drying the site after these events. I explained how dampness is not an incision’s friend, and stressed the importance of keeping incisions clean and dry for proper healing. The owner was very frustrated with the progress of the surgical site, but I have no control over how fast an incision can heal, or the environment in which the
Work on yourself outside of vet med. Learn to bring your best self to work every day. This means you need to fill up your bucket and believe in yourself before you can show up
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dog lives. These are facts we must deal with, but it is not our fault or wrongdoing. It’s just how it is. We must work with the situation to get healing to happen. This is practicing. It is the art of telling owners how to get the best outcome for their pets while knowing we cannot possibly predict all the scenarios that could happen. We have to roll with the punches, and not apologize for them. Instead, acknowledge the situation and offer guidance and expertise. This is why scheduling a follow-up exam (and having the owner pay for it, since it is your valuable time and expertise they are paying for) is vitally important for every medical and surgical case, so you can assess whether the patient has resolved their issue or not. Always do this! It’s how you learn and address client and patient concerns.
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MEDICINE FOLLOWS RULES, KNOW THEM; PATIENTS DON’T ALWAYS FOLLOW RULES, KNOW THAT TOO.
Just when you think you have figured it out, another curve ball comes your way. This is why I love this profession so much. I am always learning. Just when I think: Wow, I am really getting the swing of things, a case comes along that is not so easy or really doesn’t go by the books. This can be discouraging, especially for young veterinarians, but know you are not alone. I have been practicing for a long time and am still learning every single day. Never shut off the learning switch; there is always an opportunity to learn more in this profession.
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THERE’S LOTS OF WAYS TO SKIN A CAT, SO TO SPEAK: RESPECT OTHER CLINICIANS AND THEIR MEDICINE.
One thing that disappoints me most is when I see a veterinarian throw another veterinarian under the bus. We are all in this profession together, and passing judgements without comprehensive information is not recommended. If you believe a veterinarian has not performed in the best interests of a patient, then calling and communicating with that veterinarian is always the best next step. This can be difficult and uncomfortable, but I would prefer to have another veterinarian educate me rather than talking about me to others.
Case example I once saw a rabbit for a second opinion, and learned that the veterinarian before me prescribed Clavamox, which is contraindicated in rabbits. I stopped this medication, explained to the owner that I do not use Clavamox in rabbits because I have better options, then called the veterinarian and explained why this medication is not indicated for rabbits. I never told the client that Clavamox was contraindicated, and that their veterinarian was wrong to prescribe it. I simply explained that I do not use it in rabbits and made a different choice. You can change treatment plans without tearing others apart. Please choose your words carefully. We are here to build one another up, not tear one another down. I can hear some of you saying: “But what if it’s malpractice and they killed the patient?” Reaching out to the veterinarian directly is still the best course of action. If that veterinarian will not speak to you, then seeking guidance from your state’s veterinary medical board would be best.
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YOU DO NOT HAVE TO BE AMAZING AT EVERYTHING: BE REALLY GOOD AT WHAT YOU ENJOY AND ASK FOR HELP WHEN YOU NEED IT.
You have many lifelines in vet med. You can phone a friend, text a teacher, consult with a specialist. There are multiple avenues through which to get answers. Figuring out who to consult with, and doing it, is key. This is a journey of constant learning. Don’t be afraid to say, “I don’t know what this is, but I can find out for you or refer you to someone who does.” Admitting your limitations is bold, brave and courageous, and also represents a level of self-awareness and honesty about acknowledging the boundaries of your abilities, knowledge, or skills. It reflects humility and a realistic understanding of what you can and cannot do. This acknowledgment can be a sign of maturity and a willingness to learn and grow by recognizing areas for improvement. When you have asked for help or referred a case to someone else, read the referral paperwork thoroughly and learn what they did, why they did it, and how they figured it out. This is free education for you. Also, when you refer, be sure to dot your i’s and cross your t’s by sending a thorough history of the patient, comprehensive physical exam findings, your rule-outs and thoughts. As well, do the basic diagnostics (CBC/Chem/ T4/UA/Rads/fecal or other basic tests) to show you have a minimum data set and have not missed the obvious.
Case example Early on in my career, I once referred a seven-year-old female spayed Boxer to a local neurologist for bouts of seizures. She appeared jittery and would spin in circles. I had seen the dog three times, with normal bloodwork and neurologic findings (I didn’t do a UA, fecal, or radiographs). Turns out she had scabies! She was itchy, which is why she was spinning in circles. I was very embarrassed, but I put on my big girl pants, called the neurologist, and said: “Hi Dr. Neurofantastic Specialist, how did I miss this? Can you help me recognize the difference between a dopey Boxer spinning in circles, and one that’s itching?” And she did. She was wonderful, and told me that when you do a physical exam to scratch the dog. If he goes nuts and starts to scratch himself, you know it’s itchiness and not neurological. Duh! I thought to myself, but what a great basic tip for me as a new vet. This career has been very rewarding to me in so many ways. It has grown my knowledge base, built up my confidence, and humbled me too many times to count. In my sophomore year of undergraduate school, my organic chemistry professor announced at the first class: “My job is to teach you. You don’t know anything.” As a 19-year-old embarking on my second year of college, I thought: “This professor is nuts!” Little did I know it would make crystal clear sense to me more than 20 years later. Embracing the realization that one doesn't know everything is a crucial step towards continuous learning and personal and professional growth. IVC Spring 2024
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INTEGRATIVE APPROACH
TO TREATING LIVER DISEASE IN FELINES BY NANCY BRANDT, DVM, OMD, MSOM, DIP. OM, CVC, CVA, CVMA
Liver disease in cats has several causes, and can rapidly become serious. An integrative approach that includes diet, IV therapies, castor oil packs and more can help manage the condition over the long term.
Liver disease in cats can quickly become life-threatening. The number one cause is fatty liver syndrome or hepatic lipidosis, usually secondary to cholangitis. Other causes can include cancer, toxins and infection. This article discusses an integrative approach to treating liver disease in felines.
LIVER FUNCTIONS AND DISEASE SYMPTOMS The liver performs many functions, such as aiding digestion (especially fats), synthesizing proteins and hormones, metabolizing and eliminating toxic and waste products, and regulating the immune system. Liver disease can quickly cause multiple symptoms, the most common of which are inappetence, lethargy and weight loss. Signs of liver disease that veterinarians should educate pet guardians about include nausea, vomiting and anorexia. Rapid weight loss is a precursor to fatty liver disease and lethargy may be the first sign that anything is wrong. Signs of progressed liver disease are jaundice and ascites. On physical exam, a feline patient may have tenderness in the upper right quadrant of the abdomen. Any cat that stops eating longer than three days should always have diagnostics done and interventions begun before the liver disease can progress. Guardians should pay special attention to their cats’ eating habits.
DIAGNOSTICS AND TREATMENT The primary diagnostic tools are liver chemistries, abdominal radiographs and ultrasound, and possible liver biopsies. Testing should also be done for B12 and vitamin D3 levels. • The number one approach to treatment is to make sure the cat is taking in nutrition. Often, this will mean putting in a feeding tube. The advantage of a feeding tube is that it makes it very easy to administer medications. The disadvantage is cost, and the concerns of the guardian. I have found the best option is an esophagealgastric tube. It results in fewer infections as the gastric tube stays in better than a nasogastric tube, and does not plug as easily.
PREVENTING LIVER DISEASE Healthy digestion is the best way to keep the liver from being overused and becoming diseased. An evolutionary appropriate raw food diet can help prevent liver disease. For supplements, include apple cider vinegar (1-2 drops a day to promote liver health), digestive enzymes, probiotics, ox bile, and fermented minerals to support digestion.
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• My general treatment for any liver disorder is to support the enzyme systems of detoxification. The preferred supplement for base treatment is Thorne Mediclear Plus. Cats accept the vanilla flavor and it is easy to put in a feeding tube or even mix into food if the cat is eating. Often, we will keep cats on this product for years at 1/8 tsp PO BID per 10 pounds.
diet, raw or lightly-cooked rabbit or duck is best since they contain only 10% to 15% carbohydrate content. Often, I will add milk thistle at 70% to 80% silymarin, dandelion root, and turmeric to boost the Mediclear.
ONGOING MANAGEMENT
• In a case of severe cholangitis, we will include castor oil packs with biologically active essential oils of ledum and cypress (2-3 drops each in 2 tbsp of castor oil on an organic cotton flannel, wrapped in place for 30 minutes each day).
I check my patients’ liver chemistries at least once every three months to watch for any upward trending, and repeat IV therapies to prevent appetite loss and hepatic lipidosis. Many guardians will continue the castor oil packs on a monthly basis to support their cats’ liver health, and feed Gogi Berry juice to keep their livers happy, along with an appropriate raw or lightly-cooked diet of duck or rabbit.
• As a flush, I will also very slowly administer IV glutathione at 200mg/ml diluted in 2.5 ml dextrose. (Never use glutathione with an electrolyte solution of any kind or you will damage the kidney.) I will do IV once a week for four weeks. At the same time, I will also do IV fluids with B complex using a slow IV drip. Additionally, I will administer B12 injectable 500mcg Methocabalomin into UB 20 and 21.
Cats with long-term liver disease can do very well, with no reoccurrences, if their diet is appropriate to a true carnivore. Monthly B12 injections over the long term are also often beneficial for GI health. Digestive enzymes and probiotics should be included in a healthy carnivore diet; both play a part in liver recovery, since gut health will impact liver health.
• I sometimes use acupuncture for appetite stimulation, using ST36, SP6, LV3 and LI4 and CV12, with the B12 injection given into the back Shu points of UB18-21 and 23. Included in the B12 injection are homeopathics beneficial to the liver and GI motility.
Overall, appetence is the number one monitoring tool for both GI and liver health. Guardians should be made aware of the importance of their cats’ daily food intake, and that any appetite loss should be checked out as soon as possible.
• When the cat is eating again, I will continue the Mediclear and add in the TCM formula Bu Gan Tang (Kan liquid) at 5 drops PO BID or gycerine tincture. I also use hepatrophin PMG ½ PO BID from Standard Process. For
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From the VBMA
The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals.
DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Nettle seed (Urtica dioica) is one of the most amazing kidney trophorestoratives for degenerative kidney diseases, including glomerulonephritis, Berger’s disease (IgA nephropathy) and chronic nephritis with degeneration. Herbalist David Winston often combines it with processed rehmannia, Dan Shen (Salvia miltiorrhiza), cordyceps, astragalus or rhubarb root. Nettle seed with other nephro-supportive herbs has been highly successful at improving impaired kidney function in dogs, cats, and horses. There are also two published case reports of nettle seed helping people get off dialysis. The lectins in the seed seem to be the active compounds, and have a specificity for renal tissue.
harder-to-treat organisms such as mycoplasmas, which are implicated in this recent “mysterious canine respiratory disease”. The webinar also included some simple home remedies for prevention. We have quite an arsenal of botanical medicines able to deal with these more uncommon and/or opportunistic organisms. For example, thyme, a common kitchen spice, has a strong antimycoplasma effect. The VBMA is planning two other webinars during the year. Stay tuned at vbma.org; webinars are also available for purchase.
UPCOMING EVENTS •
The VBMA track at this year’s AHVMA (September 28 to October 1 in Reno, Nevada) will feature Chanchal Cabrera, a renowned herbalist, author, and educator. With over 40 years’ experience in the field of herbal medicine, she is recognized as a leading authority in herbal oncology. Chanchal’s expertise lies in bridging the gap between traditional herbal knowledge and modern scientific understanding, making her a valuable resource for those seeking natural health solutions. She interned with master herbalist Donnie Yance and brings his wealth of knowledge to us with all her clinical experience.
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The VBMA will hold an Eco-Tour this fall, starting at the Belknap Hot Springs in Oregon, for three days of hiking and mushroom hunting in the woods; we will also go to the Mt. Pisagah Mushroom Festival in Eugene on November 27. Specific dates for the Eco-Tour are still being finalized.
CASE REPORT Copernicus was a 25-yearold DSH male castrated cat. When in his late teens, his kidneys started to fail, with lack of appetite, vomiting, dilute urine, and secondary dehydration. His creatinine was 5.4 (0.6-2.4 mg/dl). He was given a combination of nettle seed, cordyceps, and a Chinese formula called Rehmannia 8. He lived an additional seven years. Copernicus’ creatinine returned to normal levels after six months on the herbal formula, and remained normal until his gentle passing from extreme old age.
WEBINAR ON RESPIRATORY ISSUES The VBMA is off to a fantastic start this year. They offered a membership special, along with a greatly discounted webinar about respiratory issues held on January 30. In light of the recent media scare about an unusual respiratory illness in dogs, the VBMA would like all its members to be prepared to treat any oddly-presenting respiratory issues. For the webinar, Dr. Constance DiNatale discussed Chinese patent formulas, nutraceuticals, and dietary measures, while Dr. Cynthia Lankenau finished the talk by discussing herbs that are effective against some of the odder/
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Submitted by Cynthia Lankenau, DVM
GUESS THIS HERB!
Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.
In the news
Veterinary mid-level practitioner role gains traction in Colorado and Florida
In response to the growing shortage of veterinarians and veterinary technicians, proposals to establish a veterinary mid-level practitioner role, akin to a nurse practitioner or physician assistant in human medicine, are gaining momentum in Colorado and Florida. The introduction of bills and ballot initiatives in these states marks a pivotal moment in the veterinary profession, with advocates and opponents engaging in a heated debate over the potential impact of such a role. Advocates argue that creating a veterinary professional associate (VPA) position would address critical shortages in the field while enhancing access to affordable veterinary care. With the passage of a bill in the Florida House, which received unanimous support, and a pending ballot measure in Colorado, proponents are optimistic about the prospects of establishing a state credential for VPAs. The proposed VPAs would be granted a scope of practice encompassing tasks traditionally reserved for veterinarians, including diagnosing conditions,
providing prognoses, and performing surgical procedures such as spaying and castration. This expanded role, advocates contend, would alleviate the burden on existing veterinary professionals and improve access to essential services, particularly in underserved areas. However, opponents voice concerns about the potential risks associated with introducing VPAs into the veterinary landscape. They argue that such a role may not effectively address shortages and could compromise the quality of care provided to animals. Critics warn of the inherent limitations in the training and expertise of VPAs compared to licensed veterinarians, raising apprehensions about the safety and well-being of animal patients under their care.
the hands of voters, who will have the opportunity to weigh in on the issue come November. Colorado and Florida have emerged as focal points in the push to establish a veterinary mid-level practitioner role, with stakeholders on both sides of the debate closely monitoring developments. As the discussion unfolds, the future of veterinary care in these states hangs in the balance, awaiting a resolution that weighs the need for accessibility with concerns for animal welfare and safety. https://www.myfloridahouse.gov/Sections/Bills/ billsdetail.aspx?BillId=79937&SessionId=103 and https://leg.colorado.gov/content/establishqualifications-and-registration-veterinaryprofessional-associate
The recent passage of the VPA bill in the Florida House signifies a significant milestone in the legislative process, with the measure now advancing to the Senate for further consideration. Meanwhile, in Colorado, the fate of the proposed ballot initiative rests in
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